MEDICARE: JINISE TRUEBLOOD 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	11571	MN
2	2251P0200X	Pediatric Physical Therapist	21612	MT

General Provider Information

NPI Number	:	1275193047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINISE TRUEBLOOD DPT

Provider Business Mailing Address
First Line	:	500 12TH AVE W STE 2A
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3818
Country	:	US
Telephone Number	:	406-471-1117
Fax Number	:	406-309-2076

Provider Business Practice Location Address
First Line	:	500 12TH AVE W STE 2A
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3818
Country	:	US
Telephone Number	:	406-471-1117
Fax Number	:	406-309-2076

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	01/31/2022

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