Provider Demographics
NPI:1235562893
Name:SLABAUGH, AMY (PT, DPT, LMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SLABAUGH
Suffix:
Gender:F
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 W KAGY BLVD STE D #160
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6056
Mailing Address - Country:US
Mailing Address - Phone:406-599-1608
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR STE 111
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5819
Practice Address - Country:US
Practice Address - Phone:406-599-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-18
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-9310225100000X
WAMA 60389508174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1235562893OtherMEDICARE