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General NPI Number Information
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NPI Number | 1265729156
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Entity Type | Organization
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Legal Business Name | PAULA R HUSTON
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Dates
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Enumeration Date | 06/30/2011
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 3100 PARK ST
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City | MISSOULA
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State | MT
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Zip | 59801-8757
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Country | US
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Telephone | 406-543-7457
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 PARK ST
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City | MISSOULA
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State | MT
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Zip | 59801-8757
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Country | US
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Telephone | 406-543-7457
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Fax |
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Authorized Official
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Title or Position | PT/OWNER
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Name | MS. PAULA RAE HUSTON
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Credential | PT
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Telephone | 406-543-7457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 534
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License Number State | MT
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