Provider Demographics
NPI:1073762654
Name:PUCHALSKI, MARY SUZANNE (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUZANNE
Last Name:PUCHALSKI
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:SUZANNE
Other - Last Name:MCGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-239-6353
Mailing Address - Fax:
Practice Address - Street 1:1020 N 27TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0760
Practice Address - Country:US
Practice Address - Phone:406-239-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2176PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist