MEDICARE: WYNETTE FAUTH PT

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
1	225100000X	Physical Therapist	1200	MT

General Provider Information

NPI Number	:	1376911826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WYNETTE FAUTH PT

Provider Business Mailing Address
First Line	:	5330 STELLE LN
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-8459
Country	:	US
Telephone Number	:	406-862-3553
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 CLAREMONT ST
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3551
Country	:	US
Telephone Number	:	406-752-9612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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Directions to “ WYNETTE FAUTH PT” Practice Location

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