Healthcare Provider Details

I. General information

NPI: 1376756940
Provider Name (Legal Business Name): STEVEN WAYNE COON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 23RD AVE SUITE 500
MISSOULA MT
59803-1163
US

IV. Provider business mailing address

435 S CRYSTAL ST STE 400
BUTTE MT
59701-1506
US

V. Phone/Fax

Practice location:
  • Phone: 406-626-0400
  • Fax: 406-626-0401
Mailing address:
  • Phone: 406-496-3400
  • Fax: 406-496-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1362
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: