Provider Demographics
NPI:1114390549
Name:MYOFASCIAL RELEASE OF MONTANA
Entity Type:Organization
Organization Name:MYOFASCIAL RELEASE OF MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:JFB EXPERT MYOFASCIAL RELEASE PRACT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASEK
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/CHT
Authorized Official - Phone:406-794-9139
Mailing Address - Street 1:2309 CRIMSON LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-4717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2309 CRIMSON LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-4717
Practice Address - Country:US
Practice Address - Phone:406-794-9139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 174400000X
MTOTP-OT-LIC-795261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain