Isabella Grace Callis
Individual provider Active NPI Athletic Trainer · Missoula, MT
NPI 1871017004 · NPPES record last updated Jul 30, 2017
Key facts
- NPI
- 1871017004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- ATR-LAT-LIC-1557 (MT)
- Practice address
- 32 Campus Dr
Missoula, MT 59812-0003 - Phone
- (406) 243-5355
- NPI assigned
- Jul 30, 2017
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATR-LAT-LIC-1557 | MT | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | ATR-LAT-LIC-1557 | MT | Yes |
Addresses
Primary practice location
32 Campus Dr
Missoula, MT 59812-0003
Mailing address
1225 S Higgins Ave Apt a
Missoula, MT 59801-4155
Phone (605) 838-5063
Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.