Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 733 | MT |
N | 2251S0007X | Physical Therapist - Sports | 733 | MT |
NPI | 1174799266 |
---|---|
Provider Name | John Jay Mitman |
First Address | Hamilton, MT 59840-9216 |
Second Address | Hamilton, MT 59840-9216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 08/05/2008 |