Provider Demographics
NPI:1275866162
Name:EHLERT, CARMEN ANNE (PTA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ANNE
Last Name:EHLERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3476
Mailing Address - Country:US
Mailing Address - Phone:406-265-4805
Mailing Address - Fax:406-265-4834
Practice Address - Street 1:820 2ND ST W
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3476
Practice Address - Country:US
Practice Address - Phone:406-265-4805
Practice Address - Fax:406-265-4834
Is Sole Proprietor?:No
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2177225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant