Provider Demographics
NPI:1912966912
Name:REESOR, LANCE S (MSPT)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:S
Last Name:REESOR
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 TURQUOISE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-3266
Mailing Address - Country:US
Mailing Address - Phone:406-535-6717
Mailing Address - Fax:
Practice Address - Street 1:211 MCKINLEY ST STE 1
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2353
Practice Address - Country:US
Practice Address - Phone:406-535-5001
Practice Address - Fax:406-535-5003
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3402035Medicaid
MT3402035Medicaid