Provider Demographics
NPI:1366636193
Name:PRESCOTT, MISTY ANN (CMT)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:TRINITY
Other - Middle Name:MASSAGE
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC
Mailing Address - Street 1:1 14TH AVE W
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-5306
Mailing Address - Country:US
Mailing Address - Phone:406-270-8394
Mailing Address - Fax:
Practice Address - Street 1:1 14TH AVE W
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5306
Practice Address - Country:US
Practice Address - Phone:406-270-8394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist