Provider Demographics
NPI:1124307913
Name:DUBOIS, ABBY M (LMP)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:M
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:LMP
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 9826
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-2826
Mailing Address - Country:US
Mailing Address - Phone:406-471-9990
Mailing Address - Fax:
Practice Address - Street 1:38 E WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3975
Practice Address - Country:US
Practice Address - Phone:406-471-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT534225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist