Provider Demographics
NPI:1962136721
Name:TOWNE, BRIE MIRISSA (LMT)
Entity type:Individual
Prefix:
First Name:BRIE
Middle Name:MIRISSA
Last Name:TOWNE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BRIE
Other - Middle Name:MIRISSA
Other - Last Name:COVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:PABLO
Mailing Address - State:MT
Mailing Address - Zip Code:59855-0005
Mailing Address - Country:US
Mailing Address - Phone:406-314-2626
Mailing Address - Fax:406-883-6761
Practice Address - Street 1:801 4TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-7020
Practice Address - Country:US
Practice Address - Phone:406-314-2626
Practice Address - Fax:406-883-6761
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-9663225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist