Provider Demographics
NPI:1013660398
Name:MORRISON, MICHELLE L (LMT, CSCS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MORRISON
Suffix:
Gender:F
Credentials:LMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N 22ND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7031
Mailing Address - Country:US
Mailing Address - Phone:406-624-0022
Mailing Address - Fax:406-624-0023
Practice Address - Street 1:1910 N 22ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7031
Practice Address - Country:US
Practice Address - Phone:406-624-0022
Practice Address - Fax:406-624-0023
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist