Healthcare Provider Details

I. General information

NPI: 1235562893
Provider Name (Legal Business Name): AMY SLABAUGH PT, DPT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2013
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 FAIRWAY DR STE 111
BOZEMAN MT
59715-5819
US

IV. Provider business mailing address

280 W KAGY BLVD STE D #160
BOZEMAN MT
59715-6056
US

V. Phone/Fax

Practice location:
  • Phone: 406-599-1608
  • Fax:
Mailing address:
  • Phone: 406-599-1608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 60389508
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-LIC-9310
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: