Provider Demographics
NPI:1174812762
Name:ALZHEIMER, ANASTASIA AGNES (NCTMB, LMT, CMT)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:AGNES
Last Name:ALZHEIMER
Suffix:
Gender:F
Credentials:NCTMB, LMT, CMT
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:ALZHEIMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCTMB, LMT, CMT
Mailing Address - Street 1:1351 STONERIDGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7079
Mailing Address - Country:US
Mailing Address - Phone:406-570-8025
Mailing Address - Fax:
Practice Address - Street 1:1351 STONERIDGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7079
Practice Address - Country:US
Practice Address - Phone:406-570-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT592225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist