=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366442717
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL HAMBLOCK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 07/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3718 E LAKE DR SUITE A
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-494-7050
-----------------------------------------------------
Fax | 406-494-1424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3718 E LAKE DR SUITE A
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-494-7050
-----------------------------------------------------
Fax | 406-494-1424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MIKE H HAMBLOCK
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 406-494-7050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 374PT
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------