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NPI Code Detail

MEDICARE: DR. JEFFREY ERNEST HUMPHREY DPT

MEDICARE: DR. JEFFREY ERNEST HUMPHREY DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical Therapist1699PTMT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00708924OTHERMTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
161278OTHERMTBLUECROSS BLUESHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073662169
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY ERNEST HUMPHREY DPT
Provider Business Mailing Address
First Line : 1016 BROOKS AVE
Second Line :
City : CORVALLIS
State : MT
Zip : 59828-9340
Country : US
Telephone Number : 406-961-3841
Fax Number : 406-961-6814
Provider Business Practice Location Address
First Line : 1016 BROOKS AVE
Second Line :
City : CORVALLIS
State : MT
Zip : 59828-9340
Country : US
Telephone Number : 406-961-3841
Fax Number : 406-961-6814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 12/08/2009

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Practice Location Address:
1016 BROOKS AVE
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1780875500 — MRS. GAYLE CHRISTENSEN P.T.
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1245768183 — BITTERROOT PHYSICAL THERAPY LLC
Practice Location Address:
1016 BROOKS AVE
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