Healthcare Provider Details

I. General information

NPI: 1134866189
Provider Name (Legal Business Name): JARED WINSLOW DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 W 9TH ST
LIBBY MT
59923-1766
US

IV. Provider business mailing address

25 HERITAGE WAY
KALISPELL MT
59901-3100
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-8942
  • Fax:
Mailing address:
  • Phone: 406-407-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24315
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: