Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 9632 | MT |
NPI | 1043729205 |
---|---|
Provider Name | Andrea Lynn Hildreth |
First Address | Great Falls, MT 59405-5161 |
Second Address | Great Falls, MT 59405-5161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2017 |
Last Update Date | 20/09/2017 |