Provider Demographics
NPI:1518597889
Name:RUSSELL-NYGARD, LAURA M (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:RUSSELL-NYGARD
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 1:1472 MT HIGHWAY 83
Mailing Address - Street 2:
Mailing Address - City:GREENOUGH
Mailing Address - State:MT
Mailing Address - Zip Code:59823-9629
Mailing Address - Country:US
Mailing Address - Phone:406-552-9568
Mailing Address - Fax:
Practice Address - Street 1:1472 MT HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:GREENOUGH
Practice Address - State:MT
Practice Address - Zip Code:59823-9629
Practice Address - Country:US
Practice Address - Phone:406-552-9568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1249225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist