Provider Demographics
NPI:1225774516
Name:RETREAT TO WELLNESS LC LLC
Entity Type:Organization
Organization Name:RETREAT TO WELLNESS LC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:406-927-5554
Mailing Address - Street 1:PO BOX 23116
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-3116
Mailing Address - Country:US
Mailing Address - Phone:406-927-5554
Mailing Address - Fax:406-371-7286
Practice Address - Street 1:711 CENTRAL AVE STE 223
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5889
Practice Address - Country:US
Practice Address - Phone:406-927-5554
Practice Address - Fax:406-281-8924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty