MEDICARE: JOHN JAY MITMAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	733	MT
2	2251S0007X	Sports Physical Therapist	733	MT

General Provider Information

NPI Number	:	1174799266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JAY MITMAN PT

Provider Business Mailing Address
First Line	:	472 TAMMANY LN
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-9216
Country	:	US
Telephone Number	:	406-363-2816
Fax Number	:	406-363-2816

Provider Business Practice Location Address
First Line	:	472 TAMMANY LN
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-9216
Country	:	US
Telephone Number	:	406-363-2816
Fax Number	:	406-363-2816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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Directions to “ JOHN JAY MITMAN PT” Practice Location

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