Provider Demographics
NPI:1033494059
Name:PETRIE, SHAWN (PT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:PETRIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N STE 10W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7503
Mailing Address - Country:US
Mailing Address - Phone:406-238-6400
Mailing Address - Fax:406-238-6464
Practice Address - Street 1:2900 12TH AVE N STE 10W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7503
Practice Address - Country:US
Practice Address - Phone:406-238-6400
Practice Address - Fax:406-238-6464
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist