Provider Demographics
NPI:1528323896
Name:CLOS, CHERIE ANN (LMT)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:ANN
Last Name:CLOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:
Other - Last Name:CLOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1242 BIG PINES LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-5729
Mailing Address - Country:US
Mailing Address - Phone:406-239-0181
Mailing Address - Fax:
Practice Address - Street 1:334 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4618
Practice Address - Country:US
Practice Address - Phone:406-239-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-264225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist