Provider Demographics
NPI:1740528769
Name:FAUHL, LINDA HAILE (LMT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:HAILE
Last Name:FAUHL
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 1:25 S EWING ST
Mailing Address - Street 2:SUITE 518
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5938
Mailing Address - Country:US
Mailing Address - Phone:406-431-8683
Mailing Address - Fax:
Practice Address - Street 1:25 S EWING ST
Practice Address - Street 2:SUITE 518
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5938
Practice Address - Country:US
Practice Address - Phone:406-431-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1092225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist