1457982951 NPI number — KELSIE LINDAHL LMT

Table of content: KELSIE LINDAHL LMT (NPI 1457982951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457982951 NPI number — KELSIE LINDAHL LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINDAHL
Provider First Name:
KELSIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457982951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36995 BAPTISTE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RONAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59864-8653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-250-3112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 9TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POLSON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59860-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-250-3112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  15964 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X , with the licence number: LMT-LMT-LIC-15964 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LMT-LMT-LIC-15964 . This is a "MONTANA MASSAGE BOARD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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