Healthcare Provider Details

I. General information

NPI: 1639205719
Provider Name (Legal Business Name): JASON BROOKS LUNDEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1823 W COLLEGE ST STE 100
BOZEMAN MT
59715-4915
US

IV. Provider business mailing address

1823 W COLLEGE ST STE 100
BOZEMAN MT
59715-4915
US

V. Phone/Fax

Practice location:
  • Phone: 406-556-0562
  • Fax: 406-556-0965
Mailing address:
  • Phone: 406-556-0562
  • Fax: 406-556-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2351PT
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2351PT
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7805
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: