Provider Demographics
NPI:1649243239
Name:DANE, REBECCA JO (LMT , C S T)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JO
Last Name:DANE
Suffix:
Gender:F
Credentials:LMT , C S T
Other - Prefix:
Other - First Name:MOBILE
Other - Middle Name:
Other - Last Name:MASSAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:643 GRANTSDALE RD TRLR 17A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3346
Mailing Address - Country:US
Mailing Address - Phone:406-207-2352
Mailing Address - Fax:
Practice Address - Street 1:274 OLD CORVALLIS RD UNIT S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3213
Practice Address - Country:US
Practice Address - Phone:406-375-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT533172V00000X, 173C00000X, 174400000X, 251G00000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist
No251G00000XAgenciesHospice Care, Community Based