Provider Demographics
NPI:1619726445
Name:BUMGARNER, KYLEE (LMT)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:BUMGARNER
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 1:1126 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8580
Mailing Address - Country:US
Mailing Address - Phone:406-600-4136
Mailing Address - Fax:
Practice Address - Street 1:6300 JACKRABBIT LN STE 4
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8967
Practice Address - Country:US
Practice Address - Phone:406-600-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-15999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist