Healthcare Provider Details

I. General information

NPI: 1184086894
Provider Name (Legal Business Name): MATTHEW HUSTAD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 WELLNESS WAY
BOZEMAN MT
59718-2402
US

IV. Provider business mailing address

3180 DREDGE DR SUITE F
HELENA MT
59602-0561
US

V. Phone/Fax

Practice location:
  • Phone: 406-898-1200
  • Fax:
Mailing address:
  • Phone: 406-449-0654
  • Fax: 406-449-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: