Organization
BLACK DOG PERFORMANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENNA ADELE DWYER LMT (OWNER)
(425) 686-4349
Entity
Organization
Contact information
Practice address
2245 W KOCH ST STE A, BOZEMAN, MT 59718-4013
(406) 585-7000
Mailing address
PO BOX 10261, BOZEMAN, MT 59719-0261
(425) 686-4349
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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