MEDICARE: URSULA MATTSON P.T.

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	814	MT

General Provider Information

NPI Number	:	1689849044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URSULA MATTSON P.T.

Provider Business Mailing Address
First Line	:	PO BOX 256
Second Line	:
City	:	EAST GLACIER PARK
State	:	MT
Zip	:	59434-0256
Country	:	US
Telephone Number	:	406-226-4451
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 2ND ST W
Second Line	:
City	:	HAVRE
State	:	MT
Zip	:	59501-3476
Country	:	US
Telephone Number	:	406-265-4805
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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