Provider Demographics
NPI:1083006837
Name:VINCENT, ANTONETTE (LMT)
Entity type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:
Last Name:VINCENT
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:PO BOX 1293
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-1293
Mailing Address - Country:US
Mailing Address - Phone:406-291-4544
Mailing Address - Fax:
Practice Address - Street 1:1201 US HIGHWAY 10 W STE C
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-9022
Practice Address - Country:US
Practice Address - Phone:406-291-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT673225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist