Healthcare Provider Details

I. General information

NPI: 1891731071
Provider Name (Legal Business Name): SHAD JAMES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W MAIN ST SUITE 218
BELGRADE MT
59714-3700
US

IV. Provider business mailing address

420 N 9TH AVE
BOZEMAN MT
59715-3330
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-4988
  • Fax: 406-388-6188
Mailing address:
  • Phone: 406-219-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3832
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2032
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: