Provider Demographics
NPI:1801613385
Name:FLAMING, MARYSSA (LMT)
Entity type:Individual
Prefix:
First Name:MARYSSA
Middle Name:
Last Name:FLAMING
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 CLARKS POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-8513
Mailing Address - Country:US
Mailing Address - Phone:208-512-9415
Mailing Address - Fax:
Practice Address - Street 1:3127 CENTRAL AVE STE 5
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6789
Practice Address - Country:US
Practice Address - Phone:406-901-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-27150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist