Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 534 | MT |
NPI | 1124186580 |
---|---|
Provider Name | Ms. Paula Rae Huston |
First Address | Missoula, MT 59801 |
Second Address | Missoula, MT 59801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060726 | BCSS (01) | |
347945 | (05) | MT |
5605301 | (05) | MT |