Provider Demographics
NPI:1396082418
Name:CLOUD, HENRY MOON (LMT)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:MOON
Last Name:CLOUD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 MIDDLE BURNT FORK RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6649
Mailing Address - Country:US
Mailing Address - Phone:406-239-4817
Mailing Address - Fax:406-728-0978
Practice Address - Street 1:2204 DIXON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8224
Practice Address - Country:US
Practice Address - Phone:406-239-4817
Practice Address - Fax:406-728-0978
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist