Provider Demographics
NPI:1376911826
Name:FAUTH, WYNETTE (PT)
Entity Type:Individual
Prefix:
First Name:WYNETTE
Middle Name:
Last Name:FAUTH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 STELLE LN
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8459
Mailing Address - Country:US
Mailing Address - Phone:406-862-3553
Mailing Address - Fax:
Practice Address - Street 1:25 CLAREMONT ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3551
Practice Address - Country:US
Practice Address - Phone:406-752-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist