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General NPI Number Information
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NPI Number | 1982216834
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Entity Type | Individual
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Provider Name | ROSEMARY A STOUDT LMT
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Gender | Female
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 415 N HIGGINS AVE STE 128
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City | MISSOULA
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State | MT
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Zip | 59802-4563
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Country | US
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Telephone | 406-880-8060
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Fax |
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Provider Business Mailing Address
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Address Line | 336 S 5TH ST E APT 3
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City | MISSOULA
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State | MT
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Zip | 59801-2742
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Country | US
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Telephone | 406-880-8060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 1314
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 00020119
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License Number State | WA
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