Individual
MS. TANYA R STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
825 W KENT AVE, MISSOULA, MT 59801-6619
(406) 544-6679
Mailing address
825 W KENT AVE, MISSOULA, MT 59801-6619
(406) 544-6679
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT-LIC-2019
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LMT-LIC-2019
MASSAGE LICENSE
MT
Enumeration date
04/05/2018
Last updated
04/05/2018
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