Provider Demographics
NPI:1497401160
Name:BRUA, CASEY ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ANNE
Last Name:BRUA
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 1:225 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2328
Mailing Address - Country:US
Mailing Address - Phone:406-260-3939
Mailing Address - Fax:
Practice Address - Street 1:14 2ND ST W STE B
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3036
Practice Address - Country:US
Practice Address - Phone:406-260-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6435225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT041001428531OtherMONTANA STATE FUND