MEDICARE: FLATHEAD MASSAGE PROFESSIONALS, LLC

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	1312	MT

General Provider Information

NPI Number	:	1932618709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLATHEAD MASSAGE PROFESSIONALS, LLC

Provider Business Mailing Address
First Line	:	191 JEWEL BASIN CT STE 2B
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-6294
Country	:	US
Telephone Number	:	406-314-1809
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 JEWEL BASIN CT STE 2B
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-6294
Country	:	US
Telephone Number	:	406-314-1809
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	LORALEI LOUCAKIS
Credential	:	LMT
Telephone Number	:	406-314-1809

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	07/21/2022

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