Provider Demographics
NPI:1649944968
Name:HERT, MICHELLE THERESA (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THERESA
Last Name:HERT
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 1:369 ARISTOCRAT DR APT 3
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1405
Mailing Address - Country:US
Mailing Address - Phone:406-794-2691
Mailing Address - Fax:
Practice Address - Street 1:1500 POLY DR STE 206
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-1748
Practice Address - Country:US
Practice Address - Phone:406-794-2691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-2497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist