Healthcare Provider Details

I. General information

NPI: 1457314445
Provider Name (Legal Business Name): JENNIFER CATHERINE GRUBER MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 PARK AVE
SHELBY MT
59474-1663
US

IV. Provider business mailing address

320 12TH AVE N
SHELBY MT
59474-1727
US

V. Phone/Fax

Practice location:
  • Phone: 406-434-3234
  • Fax: 406-434-3252
Mailing address:
  • Phone: 406-450-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1855PT
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010734
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: