Healthcare Provider Details

I. General information

NPI: 1184801730
Provider Name (Legal Business Name): RICHARD DAVID WESTERBERG RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N OAK ST
TOWNSEND MT
59644-2306
US

IV. Provider business mailing address

1740 BEAR CANYON RD
BOZEMAN MT
59715-6659
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-3186
  • Fax: 406-266-3180
Mailing address:
  • Phone: 406-266-3186
  • Fax: 106-266-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number46
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: