Provider Demographics
NPI:1801138326
Name:SHROYER, KATHRYN LOUISE (LMT)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LOUISE
Last Name:SHROYER
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:PO BOX 6970
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6970
Mailing Address - Country:US
Mailing Address - Phone:406-761-3767
Mailing Address - Fax:
Practice Address - Street 1:1400 29TH ST S
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5353
Practice Address - Country:US
Practice Address - Phone:406-761-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4169225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist