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General NPI Number Information
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NPI Number | 1992363139
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Entity Type | Individual
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Provider Name | DOUGLAS F REEVES PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 800 KENSINGTON AVE STE 100
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City | MISSOULA
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State | MT
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Zip | 59801-5670
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Country | US
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Telephone | 406-544-1492
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Fax |
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Provider Business Mailing Address
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Address Line | 2142 BRIGGS STREET
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City | MISSOULA
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State | MT
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Zip | 59803-1126
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Country | US
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Telephone | 406-544-1492
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PTP-PT-LIC-17089
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License Number State | MT
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