Provider Demographics
NPI:1992008809
Name:YOUNG, ROBIN LEE (CMT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
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:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:MT
Mailing Address - Zip Code:59922-0742
Mailing Address - Country:US
Mailing Address - Phone:406-249-9754
Mailing Address - Fax:406-752-8012
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4452
Practice Address - Country:US
Practice Address - Phone:406-249-9754
Practice Address - Fax:406-752-8012
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT403235-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist