Provider Demographics
NPI:1770850349
Name:STUBE, ANDRIANA LEIGH (BA, LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANDRIANA
Middle Name:LEIGH
Last Name:STUBE
Suffix:
Gender:F
Credentials:BA, LMT
Other - Prefix:MRS
Other - First Name:ANDRIANA
Other - Middle Name:LEIGH
Other - Last Name:EASTWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, LMT
Mailing Address - Street 1:2421 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3145
Mailing Address - Country:US
Mailing Address - Phone:406-549-6661
Mailing Address - Fax:
Practice Address - Street 1:1203 MOUNT AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5601
Practice Address - Country:US
Practice Address - Phone:406-543-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1382225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist