Provider Demographics
NPI:1982216834
Name:STOUDT, ROSEMARY A (LMT)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:A
Last Name:STOUDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:A
Other - Last Name:STOUDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:336 S 5TH ST E APT 3
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2742
Mailing Address - Country:US
Mailing Address - Phone:406-880-8060
Mailing Address - Fax:
Practice Address - Street 1:415 N HIGGINS AVE STE 128
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4563
Practice Address - Country:US
Practice Address - Phone:406-880-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1314225700000X
WA00020119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist