Healthcare Provider Details

I. General information

NPI: 1679688840
Provider Name (Legal Business Name): JUDITH ELLEN KUIPERS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH ELLEN DEWIT PT

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 W PARK STREET SUITE 7
LIVINGSTON MT
59047
US

IV. Provider business mailing address

1313 W PARK STREET SUITE 7
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 Number198
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: