Healthcare Provider Details

I. General information

NPI: 1174486013
Provider Name (Legal Business Name): BRANDON A TUSHKA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 11TH AVE S
GREAT FALLS MT
59405-4654
US

IV. Provider business mailing address

1301 11TH AVE S
GREAT FALLS MT
59405-4654
US

V. Phone/Fax

Practice location:
  • Phone: 406-455-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number21913
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: