Individual
TERIESA BLACK RUNYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1308 12TH AVE S, GREAT FALLS, MT 59405-4607
(406) 453-8885
Mailing address
612 WILLOW CREEK CT, GREAT FALLS, MT 59405-1316
(801) 706-6330
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
260024-4701
UT
225700000X
Massage Therapist
Primary
LMT-LMT-LIC-17904
MT
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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