Individual
MARY DOLORES MANCILLAS-LOVELESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA, LMT, C.PED
Contact information
Practice address
612 1ST AVE. SO., GREAT FALLS, MT 59401
(406) 750-2655
Mailing address
3026 4TH AVENUE SOUTH, GREAT FALLS, MT 59405-3330
(406) 750-2655
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1096
MT
225700000X
Massage Therapist
568
MT
Other
Enumeration date
09/09/2011
Last updated
09/09/2011
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