Provider Demographics
NPI:1417036153
Name:BRUNETT, WILLIAM W (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:BRUNETT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SUNNYVIEW LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-3597
Mailing Address - Fax:406-756-7605
Practice Address - Street 1:906 9TH STREET WEST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912
Practice Address - Country:US
Practice Address - Phone:406-892-0681
Practice Address - Fax:406-892-0682
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT268PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT61530OtherBCBS
MT650020222OtherRR MEDICARE
MT0343468Medicaid
MT61530OtherBCBS