Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2408PT | MT |
NPI | 1003197179 |
---|---|
Provider Name | Rachael Herynk |
First Address | Missoula, MT 59801-5652 |
Second Address | Missoula, MT 59801-5652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2011 |
Last Update Date | 02/09/2011 |