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NPI Code Detail

MEDICARE: NICOLE JEANNE WALDRON DPT

MEDICARE: NICOLE JEANNE WALDRON 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
1225100000XPhysical Therapist1997MT

General Provider Information

NPI Number : 1548532112
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE JEANNE WALDRON DPT
Provider Business Mailing Address
First Line : 2901 CUSTER AVE
Second Line :
City : BILLINGS
State : MT
Zip : 59102-4522
Country : US
Telephone Number : 314-941-3630
Fax Number :
Provider Business Practice Location Address
First Line : 2115 CENTRAL AVE
Second Line :
City : BILLINGS
State : MT
Zip : 59102-4741
Country : US
Telephone Number : 406-656-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2012
Last Update Date : 01/30/2012

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