Healthcare Provider Details

I. General information

NPI: 1508605890
Provider Name (Legal Business Name): ANTHONY VERHASSELT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 W SPRUCE ST
MISSOULA MT
59802-4108
US

IV. Provider business mailing address

316 W SPRUCE ST
MISSOULA MT
59802-4108
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-9500
  • Fax: 406-541-9501
Mailing address:
  • Phone: 406-541-9500
  • Fax: 406-541-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTP-PT-LIC-29786
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: