Healthcare Provider Details

I. General information

NPI: 1518333764
Provider Name (Legal Business Name): JENNIFER BRANN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E IDAHO ST
KALISPELL MT
59901-3203
US

IV. Provider business mailing address

702 E IDAHO ST
KALISPELL MT
59901-3203
US

V. Phone/Fax

Practice location:
  • Phone: 406-502-1964
  • Fax:
Mailing address:
  • Phone: 406-502-1964
  • Fax: 406-203-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9331
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: