MEDICARE: KELLY SOLOMON LMT

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	2080	MT

General Provider Information

NPI Number	:	1285297424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY SOLOMON LMT

Provider Business Mailing Address
First Line	:	3159 GARDENBROOK LN
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-0687
Country	:	US
Telephone Number	:	406-600-1524
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 CHARLOTTE ST
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-2739
Country	:	US
Telephone Number	:	406-586-3133
Fax Number	:

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

Provider Enumeration Date	:	04/14/2019
Last Update Date	:	04/14/2019

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Directions to “ KELLY SOLOMON LMT” Practice Location

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