Provider Demographics
NPI:1942437678
Name:FOX, DUSTIN THOMMEY (CMT)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:THOMMEY
Last Name:FOX
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 W MAIN ST
Mailing Address - Street 2:PMB 244
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4011
Mailing Address - Country:US
Mailing Address - Phone:800-304-9197
Mailing Address - Fax:
Practice Address - Street 1:102 ROGERS LN
Practice Address - Street 2:MASSAGE OFFICE
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-4020
Practice Address - Country:US
Practice Address - Phone:800-304-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-21
Last Update Date:2009-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNOT REQ. BY STATE225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist