Provider Demographics
NPI:1225592389
Name:CRUSON, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:CRUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35322 WASHOE RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MT
Mailing Address - Zip Code:59823-9559
Mailing Address - Country:US
Mailing Address - Phone:406-552-3462
Mailing Address - Fax:
Practice Address - Street 1:35322 WASHOE RD
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MT
Practice Address - Zip Code:59823-9559
Practice Address - Country:US
Practice Address - Phone:406-552-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-6241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1203119904103OtherDRIVERS LICENSE