Provider Demographics
NPI:1093297202
Name:MAYER, ALENA R (BS, PTA)
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:R
Last Name:MAYER
Suffix:
Gender:F
Credentials:BS, PTA
Other - Prefix:
Other - First Name:ALENA
Other - Middle Name:R
Other - Last Name:BREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, PTA
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-0032
Mailing Address - Country:US
Mailing Address - Phone:406-925-1000
Mailing Address - Fax:
Practice Address - Street 1:203 S MAIN ST.
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752
Practice Address - Country:US
Practice Address - Phone:406-285-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PTP-PTA-LIC-10993225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant