Facts
- Status
- A
- Credential
- PT, DPT
- Type
- Individual
- Enumeration date
- 2021-06-03
- Last updated
- 2021-06-03
Specialties
Licenses
- License MT
- PTP-PT-LIC-21600
Location
- Practice location
- 4515 VALLEY COMMONS DR STE 101
- City
- BOZEMAN MT
- Postal code
- 597184531
- Phone
- 406-404-1897
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.