Provider Demographics
NPI:1952674731
Name:CORDIAL, BRITTNEA LEE (LMT)
Entity Type:Individual
Prefix:
First Name:BRITTNEA
Middle Name:LEE
Last Name:CORDIAL
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 1:701 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3904
Mailing Address - Country:US
Mailing Address - Phone:406-721-8858
Mailing Address - Fax:
Practice Address - Street 1:701 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3904
Practice Address - Country:US
Practice Address - Phone:406-721-8858
Practice Address - Fax:406-542-0960
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist