Healthcare Provider Details

I. General information

NPI: 1366546392
Provider Name (Legal Business Name): MICHAEL D CAREY LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOSPITAL WAY
WHITEFISH MT
59937-7858
US

IV. Provider business mailing address

2006 HOSPITAL WAY
WHITEFISH MT
59937-7858
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-8250
  • Fax: 406-862-9882
Mailing address:
  • Phone: 406-862-8250
  • Fax: 406-862-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number53ATR
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: