Provider Demographics
NPI:1225347529
Name:NELSON, THERESA L (CMT LMT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:CMT LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-2142
Mailing Address - Country:US
Mailing Address - Phone:406-250-9263
Mailing Address - Fax:406-756-3277
Practice Address - Street 1:1550 US HIGHWAY 93 N
Practice Address - Street 2:SPA ROOM
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3155
Practice Address - Country:US
Practice Address - Phone:406-250-9263
Practice Address - Fax:406-756-3277
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT869225700000X
INMT20902732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist