Provider Demographics
NPI:1275058653
Name:CAMPBELL, KRISTI LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 BOYLAN RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1524
Mailing Address - Country:US
Mailing Address - Phone:1406-580-7415
Mailing Address - Fax:
Practice Address - Street 1:820 N WALLACE AVE UNIT A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3024
Practice Address - Country:US
Practice Address - Phone:406-580-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-9994225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist