Healthcare Provider Details

I. General information

NPI: 1487938700
Provider Name (Legal Business Name): ASHLEY MAE WOLD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 US HWY 10 W UNIT E
LIVINGSTON MT
59047
US

IV. Provider business mailing address

1201 US HWY 10 W UNIT E
LIVINGSTON MT
59047
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-5519
  • Fax: 406-222-0366
Mailing address:
  • Phone: 406-222-5519
  • Fax: 406-222-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2435PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: