Provider Demographics
NPI:1942622873
Name:JOHNNY COCHRANE MASSAGE THERAPY, LLC.
Entity Type:Organization
Organization Name:JOHNNY COCHRANE MASSAGE THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COCHRANE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:406-871-9885
Mailing Address - Street 1:PO BOX 9933
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-2933
Mailing Address - Country:US
Mailing Address - Phone:406-871-9885
Mailing Address - Fax:
Practice Address - Street 1:43 WOODLAND PARK DR
Practice Address - Street 2:STE. 20
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4600
Practice Address - Country:US
Practice Address - Phone:406-871-9885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-12
Last Update Date:2014-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1255261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain