Provider Demographics
NPI:1619462801
Name:FLOREY, CARL WILLIAM (LMT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:WILLIAM
Last Name:FLOREY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 SHERMAN CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917
Mailing Address - Country:US
Mailing Address - Phone:406-889-5443
Mailing Address - Fax:
Practice Address - Street 1:626 SHERMAN CREEK ROAD
Practice Address - Street 2:
Practice Address - City:EUREKA,
Practice Address - State:MT
Practice Address - Zip Code:59917
Practice Address - Country:US
Practice Address - Phone:406-471-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLET-LMT-LIC-9809225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTLMT-LMT-LIC-9809OtherSTATE OF MONTANA