Provider Demographics
NPI:1285855569
Name:BAASCH, LOREE MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LOREE
Middle Name:MICHELLE
Last Name:BAASCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LOREE
Other - Middle Name:MICHELLE
Other - Last Name:RUNDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4718 23RD AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4718 23RD AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1163
Practice Address - Country:US
Practice Address - Phone:406-626-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1795PTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant