Provider Demographics
NPI:1528374709
Name:LAFOREST, JENNIFER MONICA (DPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MONICA
Last Name:LAFOREST
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N HIGGINS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4524
Mailing Address - Country:US
Mailing Address - Phone:406-542-3333
Mailing Address - Fax:406-542-3365
Practice Address - Street 1:420 N HIGGINS AVE STE B
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4524
Practice Address - Country:US
Practice Address - Phone:406-542-3333
Practice Address - Fax:406-542-3365
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2311PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist