Provider Demographics
NPI:1275193047
Name:TRUEBLOOD, JINISE (DPT)
Entity Type:Individual
Prefix:
First Name:JINISE
Middle Name:
Last Name:TRUEBLOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 12TH AVE W STE 2A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-3818
Mailing Address - Country:US
Mailing Address - Phone:406-471-1117
Mailing Address - Fax:406-309-2076
Practice Address - Street 1:500 12TH AVE W STE 2A
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-3818
Practice Address - Country:US
Practice Address - Phone:406-471-1117
Practice Address - Fax:406-309-2076
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11571225100000X
MT216122251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist