Healthcare Provider Details

I. General information

NPI: 1790877439
Provider Name (Legal Business Name): STEPHEN HISEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W KOCH ST SUITE 12
BOZEMAN MT
59715-4148
US

IV. Provider business mailing address

1700 W KOCH ST SUITE 12
BOZEMAN MT
59715-4148
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-6057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number633PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: