Provider Demographics
NPI:1255156089
Name:SIAS, TERRACE RAYMOND
Entity type:Individual
Prefix:
First Name:TERRACE
Middle Name:RAYMOND
Last Name:SIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49611 MOIESE VALLEY RD # B
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-8855
Mailing Address - Country:US
Mailing Address - Phone:406-214-0428
Mailing Address - Fax:
Practice Address - Street 1:49611 MOIESE VALLEY RD # B
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-8855
Practice Address - Country:US
Practice Address - Phone:406-214-0428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach