Individual
KELLI FACUNDUS BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
195 BOYER ST, PLAINS, MT 59859-5985
(570) 637-1122
Mailing address
45 RATTLING HORNS LN, PLAINS, MT 59859-9613
(570) 637-1122
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT-LMT-LIC-18465
MT
Other
Enumeration date
08/11/2020
Last updated
08/11/2020
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