Organization Name: | ANDREA M. ELLESTAD, LLC |
NPI Number: | 1124396601 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANDREA M. ELLESTAD (MANAGER) |
Mailing Address: | 1320 S 3rd St W Missoula |
State: | MT US |
Postal Code: | 598012332 |
Phone Number: | 4062036207 |
Fax Number: | |
NPI Enumeration Date: | 12/12/2011 |
NPI Last Update Date: | 12/12/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 1098 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |