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General NPI Number Information
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NPI Number | 1083046726
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Entity Type | Individual
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Provider Name | JESSE DUPRE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 1705 BOW ST
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City | MISSOULA
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State | MT
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Zip | 59801-5652
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Country | US
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Telephone | 406-549-5283
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Fax | 406-549-5392
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Provider Business Mailing Address
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Address Line | 425 STEPHENS AVE APT E
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City | MISSOULA
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State | MT
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Zip | 59801-3876
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Country | US
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Telephone | 406-431-5015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTP-PT-LIC5936
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License Number State | MT
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