Healthcare Provider Details

I. General information

NPI: 1902324916
Provider Name (Legal Business Name): EMILY RENE SAGSTETTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 PRONGHORN TRL
BOZEMAN MT
59718-7090
US

IV. Provider business mailing address

6034 LIBERTY GLADE CT
FORT WAYNE IN
46804-4219
US

V. Phone/Fax

Practice location:
  • Phone: 406-580-0803
  • Fax:
Mailing address:
  • Phone: 260-579-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008747-KY
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: