Healthcare Provider Details

I. General information

NPI: 1073662169
Provider Name (Legal Business Name): JEFFREY ERNEST HUMPHREY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 BROOKS AVE
CORVALLIS MT
59828-9340
US

IV. Provider business mailing address

1016 BROOKS AVE
CORVALLIS MT
59828-9340
US

V. Phone/Fax

Practice location:
  • Phone: 406-961-3841
  • Fax: 406-961-6814
Mailing address:
  • Phone: 406-961-3841
  • Fax: 406-961-6814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1699PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: