Facts
- Status
- A
- Credential
- PTA
- Type
- Individual
- Enumeration date
- 2011-09-07
- Last updated
- 2016-10-20
Specialties
Licenses
- License MT
- 2460
Location
- Practice location
- 401 W PENNSYLVANIA AVE
- City
- ANACONDA MT
- Postal code
- 597111931
- Phone
- 406-563-8590
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.