MEDICARE: JETHRO MCCONNELL DPT

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	PTP-PT-LIC-16918	MT

General Provider Information

NPI Number	:	1215896857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JETHRO MCCONNELL DPT

Provider Business Mailing Address
First Line	:	1200 WESTWOOD DR
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-2345
Country	:	US
Telephone Number	:	406-375-4570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 WESTWOOD DR
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-2345
Country	:	US
Telephone Number	:	406-375-4570
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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