Provider Demographics
NPI:1457982951
Name:LINDAHL, KELSIE (LMT)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:LINDAHL
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 1:36995 BAPTISTE RD
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-8653
Mailing Address - Country:US
Mailing Address - Phone:406-250-3112
Mailing Address - Fax:
Practice Address - Street 1:3 9TH AVE W
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5136
Practice Address - Country:US
Practice Address - Phone:406-250-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15964225700000X
MTLMT-LMT-LIC-15964225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTLMT-LMT-LIC-15964OtherMONTANA MASSAGE BOARD