Provider Demographics
NPI:1205183712
Name:STUBE, BRIAN DAVID (LMT,NCTM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:DAVID
Last Name:STUBE
Suffix:
Gender:M
Credentials:LMT,NCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BLACKTHORN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2540
Mailing Address - Country:US
Mailing Address - Phone:406-214-5901
Mailing Address - Fax:
Practice Address - Street 1:800 KENSINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5670
Practice Address - Country:US
Practice Address - Phone:406-549-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3289225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist