Healthcare Provider Details

I. General information

NPI: 1881624062
Provider Name (Legal Business Name): GARY LEE KUYKENDALL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 AVENUE B STE B
BILLINGS MT
59102-7550
US

IV. Provider business mailing address

2900 12TH AVE N STE 140W
BILLINGS MT
59101-7507
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-6535
  • Fax:
Mailing address:
  • Phone: 406-238-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number705
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: