Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTP-PT-LIC-1421 | MT |
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1063439024 |
---|---|
Provider Name | Paul T Thormahlen |
First Address | Missoula, MT 59804-7401 |
Second Address | Missoula, MT 59804-7401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 18/01/2017 |