Healthcare Provider Details

I. General information

NPI: 1093308702
Provider Name (Legal Business Name): RYAN A MACNEILL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 PROSPECT AVE STE C
HELENA MT
59601-3928
US

IV. Provider business mailing address

PO BOX 5718
KALISPELL MT
59903-5718
US

V. Phone/Fax

Practice location:
  • Phone: 406-502-1900
  • Fax: 406-502-1333
Mailing address:
  • Phone: 406-756-0134
  • Fax: 406-309-2579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-LIC-19575
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: