Doctor Name: | BRIAN DAVID STUBE |
NPI Number: | 1205183712 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LMT,NCTM |
License Number: | 3289 |
Business Practice Address: | 800 Kensington Ave Ste 201 Missoula, MT - 598015670 |
Business Phone Number: | 4065499244 |
Business Fax Number: | |
Mailing Address: | 2500 Blackthorn Dr, MISSOULA |
State: | MT |
Postal Code: | 598032540 |
Phone Number: | 4062145901 |
Fax Number: | |
NPI Enumeration Date: | 08/14/2012 |
NPI Last Update Date: | 08/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 3289 |
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. |