Provider Demographics
NPI:1538690177
Name:CROSS, MIRIAM (LMT)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 18TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:424 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4733
Practice Address - Country:US
Practice Address - Phone:406-585-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-6029225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist