Provider Demographics
NPI:1366481681
Name:YASENAK, BRYCE ALLEN (DPT)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:ALLEN
Last Name:YASENAK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3126
Mailing Address - Country:US
Mailing Address - Phone:406-375-0980
Mailing Address - Fax:406-375-9938
Practice Address - Street 1:502 N MAIN STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:DARBY
Practice Address - State:MT
Practice Address - Zip Code:59829
Practice Address - Country:US
Practice Address - Phone:406-821-2021
Practice Address - Fax:406-821-1120
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1759225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401224Medicaid
MT626010OtherBCBS