Healthcare Provider Details

I. General information

NPI: 1639279219
Provider Name (Legal Business Name): JULIETTE VAIL RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIETTE VAIL

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 FAIRWAY DR STE 107
BOZEMAN MT
59715-5819
US

IV. Provider business mailing address

1145 S SPRUCE DR
BOZEMAN MT
59715-5952
US

V. Phone/Fax

Practice location:
  • Phone: 406-412-2755
  • Fax:
Mailing address:
  • Phone: 406-209-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88146
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1024
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: