Provider Demographics
NPI:1376952374
Name:ALLEN, ELIZABETH (LMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:#204
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6241
Mailing Address - Country:US
Mailing Address - Phone:406-570-7799
Mailing Address - Fax:
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:#204
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6241
Practice Address - Country:US
Practice Address - Phone:406-570-7799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT#93225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist