Provider Demographics
NPI:1437761954
Name:GANNON, JOSEPHINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:GANNON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:KAUTSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1970 PRYOR LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-1627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:708 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2710
Practice Address - Country:US
Practice Address - Phone:406-259-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-193332251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics