MEDICARE: ABBY M DUBOIS LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	534	MT

General Provider Information

NPI Number	:	1124307913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY M DUBOIS LMP

Provider Business Mailing Address
First Line	:	PO BOX 9826
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59904-2826
Country	:	US
Telephone Number	:	406-471-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 E WASHINGTON ST
Second Line	:	SUITE C
City	:	KALISPELL
State	:	MT
Zip	:	59901-3975
Country	:	US
Telephone Number	:	406-471-9990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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