Healthcare Provider Details

I. General information

NPI: 1366481681
Provider Name (Legal Business Name): BRYCE ALLEN YASENAK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N MAIN STREET SUITE 900
DARBY MT
59829
US

IV. Provider business mailing address

336 FAIRGROUNDS RD
HAMILTON MT
59840-3126
US

V. Phone/Fax

Practice location:
  • Phone: 406-821-2021
  • Fax: 406-821-1120
Mailing address:
  • Phone: 406-375-0980
  • Fax: 406-375-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1759
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: