Provider Demographics
NPI:1316395007
Name:SITES, ANNIE M (LMT)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:M
Last Name:SITES
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 1:419 S BOZEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4810
Mailing Address - Country:US
Mailing Address - Phone:406-209-2188
Mailing Address - Fax:
Practice Address - Street 1:1919 FAIRWAY DR RM 103
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5844
Practice Address - Country:US
Practice Address - Phone:406-209-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT518225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist