Provider Demographics
NPI:1578270112
Name:NELSON, BILLIE J (LMT)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:J
Last Name:NELSON
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 1:12 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5241
Mailing Address - Country:US
Mailing Address - Phone:406-399-0701
Mailing Address - Fax:
Practice Address - Street 1:12 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5241
Practice Address - Country:US
Practice Address - Phone:406-399-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-24547225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTLMT-LMT-LIC-24547OtherSTATE LICENSE NUMBER