Provider Demographics
NPI:1700549920
Name:VERILHAC, VERONICA (LMT-LMT-LIC-969)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:VERILHAC
Suffix:
Gender:F
Credentials:LMT-LMT-LIC-969
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2902
Mailing Address - Country:US
Mailing Address - Phone:406-461-7298
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR STE 109
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5819
Practice Address - Country:US
Practice Address - Phone:406-461-7298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist