Provider Demographics
NPI:1316259740
Name:MARISCAL, RAYMOND JR
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:MARISCAL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 US HIGHWAY 93 S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5721
Mailing Address - Country:US
Mailing Address - Phone:406-752-6798
Mailing Address - Fax:
Practice Address - Street 1:1845 US HIGHWAY 93 S
Practice Address - Street 2:SUITE 205
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5721
Practice Address - Country:US
Practice Address - Phone:406-752-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT173OtherSTATE OF MONTANA, DEPARTMENT OF LABOR AND INDUSTRY