Individual
KELLY JO MCCULLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2509 7TH AVE S C-3, GREAT FALLS, MT 59405-3031
(406) 868-8046
(406) 771-6883
Mailing address
5030 71ST AVE SW, GREAT FALLS, MT 59404-5286
(406) 868-8046
(406) 771-6883
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT-LIC-1384
MT
Other
Enumeration date
03/18/2020
Last updated
03/18/2020
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