Healthcare Provider Details

I. General information

NPI: 1275016750
Provider Name (Legal Business Name): ALESE AMIDON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 08/27/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 CABERNET DRIVE SUITE 3
HELENA MT
59601-8644
US

IV. Provider business mailing address

3051 CABERNET DRIVE SUITE 3
HELENA MT
59601-8644
US

V. Phone/Fax

Practice location:
  • Phone: 406-282-1030
  • Fax: 406-422-0626
Mailing address:
  • Phone: 406-282-1030
  • Fax: 406-422-0626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PTA-LIC-15186
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number15141
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: