Provider Demographics
NPI:1558342865
Name:SPIESS, DANIEL (BSC PT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:SPIESS
Suffix:
Gender:M
Credentials:BSC PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1301 11TH AVE S
Mailing Address - Street 2:EVERGREEN MALL
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4654
Mailing Address - Country:US
Mailing Address - Phone:406-761-2222
Mailing Address - Fax:406-761-7219
Practice Address - Street 1:1301 11TH AVE S
Practice Address - Street 2:EVERGREEN MALL
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4654
Practice Address - Country:US
Practice Address - Phone:406-761-2222
Practice Address - Fax:406-761-7219
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1071PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401372Medicaid