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NPI Code Detail

MEDICARE: KELLY SOLOMON LMT

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
1225700000XMassage Therapist2080MT

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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