Healthcare Provider Details

I. General information

NPI: 1497837413
Provider Name (Legal Business Name): JENNIFER D MARLAND PT, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 SOUTH AVE W
MISSOULA MT
59804-5135
US

IV. Provider business mailing address

3463 S 400 E
BOUNTIFUL UT
84010-5816
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-6101
  • Fax:
Mailing address:
  • Phone: 801-979-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMED-PAC-LIC-172219
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number377934-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: