Healthcare Provider Details

I. General information

NPI: 1396755146
Provider Name (Legal Business Name): BRACE WILLIAM HAYDEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 BLUE MOUNTAIN RD
MISSOULA MT
59804-9213
US

IV. Provider business mailing address

5000 BLUE MOUNTAIN RD
MISSOULA MT
59804-9213
US

V. Phone/Fax

Practice location:
  • Phone: 406-251-2323
  • Fax: 406-251-2999
Mailing address:
  • Phone: 406-251-2323
  • Fax: 406-251-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1915PT
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: