Healthcare Provider Details

I. General information

NPI: 1194370270
Provider Name (Legal Business Name): REBECCA CLAIRE FISCHER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA CLAIRE BERLAND DPT

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 HARVE AVE STE 2
MISSOULA MT
59801-8332
US

IV. Provider business mailing address

1940 HARVE AVE STE 2
MISSOULA MT
59801-8332
US

V. Phone/Fax

Practice location:
  • Phone: 406-542-0808
  • Fax: 406-542-0909
Mailing address:
  • Phone: 406-542-0808
  • Fax: 406-542-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-LIC-17187
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: