Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1359PT | MT |
NPI | 1255493490 |
---|---|
Provider Name | Mark A. Dunifer |
First Address | Missoula, MT 59808-1379 |
Second Address | Missoula, MT 59808-1379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |