MEDICARE: ANGELA D LISTUG-VAP 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
1	2251X0800X	Orthopedic Physical Therapist	1941	MT
2	2251X0800X	Orthopedic Physical Therapist	32299	CA
3	2251X0800X	Orthopedic Physical Therapist	4617	OR
4	2251X0800X	Orthopedic Physical Therapist	9667	WA

General Provider Information

NPI Number	:	1750438719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA D LISTUG-VAP DPT

Provider Business Mailing Address
First Line	:	5000 BLUE MOUNTAIN RD.
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-9213
Country	:	US
Telephone Number	:	406-251-2323
Fax Number	:	406-251-2999

Provider Business Practice Location Address
First Line	:	2965 STOCKYARD RD.
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1557
Country	:	US
Telephone Number	:	406-541-2606
Fax Number	:	406-541-2607

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/23/2014

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