Provider Demographics
NPI:1821391897
Name:MERRIMAN, LORETTA ANNE (LMT, PTA)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ANNE
Last Name:MERRIMAN
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 BISON DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5104
Mailing Address - Country:US
Mailing Address - Phone:406-890-2758
Mailing Address - Fax:
Practice Address - Street 1:1711 BISON DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5104
Practice Address - Country:US
Practice Address - Phone:406-890-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1039225700000X
MT7693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant