Healthcare Provider Details

I. General information

NPI: 1578456000
Provider Name (Legal Business Name): AMBER DIAZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SW HIGGINS AVE STE 205
MISSOULA MT
59803-1340
US

IV. Provider business mailing address

1001 SW HIGGINS AVE STE 205
MISSOULA MT
59803-1340
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-3096
  • Fax: 406-721-3956
Mailing address:
  • Phone: 406-721-3096
  • Fax: 406-721-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32549
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: