Provider Demographics
NPI:1568897262
Name:MCCALLEY, VLADIMIRA (LMT,MMT)
Entity Type:Individual
Prefix:
First Name:VLADIMIRA
Middle Name:
Last Name:MCCALLEY
Suffix:
Gender:F
Credentials:LMT,MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 DURSTON RD STE 27
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2804
Mailing Address - Country:US
Mailing Address - Phone:406-581-8731
Mailing Address - Fax:
Practice Address - Street 1:2137 DURSTON RD STE 27
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2804
Practice Address - Country:US
Practice Address - Phone:406-522-0222
Practice Address - Fax:406-586-0220
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT720225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist