Provider Demographics
NPI:1023194776
Name:COULTER, AMBER (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:COULTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5578 BRIDLEPATH LANE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833
Mailing Address - Country:US
Mailing Address - Phone:406-721-3096
Mailing Address - Fax:
Practice Address - Street 1:3802 EASTSIDE HWY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2224
Practice Address - Country:US
Practice Address - Phone:406-777-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1678PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3400663Medicaid