Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PTP-PT-LIC-2424 | MT |
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1306130703 |
---|---|
Provider Name | Steven A Nystuen |
First Address | Missoula, MT 59804-5137 |
Second Address | Missoula, MT 59804-5137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2011 |
Last Update Date | 15/05/2019 |