Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | 683 | MT |
Y | 225100000X | Physical Therapist | 683 | MT |
N | 2251G0304X | Physical Therapist - Geriatrics | 683 | MT |
N | 2251N0400X | Physical Therapist - Neurology | 683 | MT |
N | 2251S0007X | Physical Therapist - Sports | 683 | MT |
N | 2251X0800X | Physical Therapist - Orthopedic | 683 | MT |
NPI | 1588767479 |
---|---|
Provider Name | Mr. Robert Allen Sahli |
First Address | Ennis, MT 59729-0921 |
Second Address | Ennis, MT 59729-0921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 10/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0345950 | (05) | MT |
061286 | BLUE CROSS BLUE SHIELD (01) | MT |
P18527 | (02) | MT |