Healthcare Provider Details

I. General information

NPI: 1700939253
Provider Name (Legal Business Name): HEATHER SUE REPAC PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER SUE WATTS PT

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 27TH ST W SUITE B
BILLINGS MT
59102-8601
US

IV. Provider business mailing address

1233 N 30TH ST
BILLINGS MT
59101-0127
US

V. Phone/Fax

Practice location:
  • Phone: 406-651-9099
  • Fax: 406-651-4332
Mailing address:
  • Phone: 406-238-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number960PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: