Provider Demographics
NPI:1316046147
Name:MARSTON, SANDRA L
Entity Type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:L
Last Name:MARSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5062 PROSPECTOR GULCH RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-6706
Mailing Address - Country:US
Mailing Address - Phone:406-442-2634
Mailing Address - Fax:406-495-8996
Practice Address - Street 1:417 N BENTON AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5041
Practice Address - Country:US
Practice Address - Phone:406-495-8995
Practice Address - Fax:406-495-8996
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPT1007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401008Medicaid