MEDICARE: MR. DANIEL MARK THIELEN 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	7442	MT

General Provider Information

NPI Number	:	1992765465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL MARK THIELEN P.T.

Provider Business Mailing Address
First Line	:	602 S CRYSTAL ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2338
Country	:	US
Telephone Number	:	320-309-8584
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 S CRYSTAL ST STE 400
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-1506
Country	:	US
Telephone Number	:	406-496-3456
Fax Number	:

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	12/05/2016

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