Provider Demographics
NPI:1144071333
Name:DEISZ, LAURENCE ANDREW (LMT)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:ANDREW
Last Name:DEISZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CARAVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-2837
Mailing Address - Country:US
Mailing Address - Phone:406-855-1560
Mailing Address - Fax:
Practice Address - Street 1:2822 3RD AVE N STE 204
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1934
Practice Address - Country:US
Practice Address - Phone:406-855-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-24552225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist