Provider Demographics
NPI:1245604057
Name:GUENZLER, FREDERICK CARL (LMT - MT387)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:CARL
Last Name:GUENZLER
Suffix:
Gender:M
Credentials:LMT - MT387
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LUBY LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833
Mailing Address - Country:US
Mailing Address - Phone:406-777-2591
Mailing Address - Fax:
Practice Address - Street 1:201 LUBY LANE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833
Practice Address - Country:US
Practice Address - Phone:406-777-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT387172M00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist