Provider Demographics
NPI:1598288847
Name:QUERCIAGROSSA, AUGUST JAKOB (DPT)
Entity Type:Individual
Prefix:
First Name:AUGUST
Middle Name:JAKOB
Last Name:QUERCIAGROSSA
Suffix:
Gender:M
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:PO BOX 11629
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59719-1629
Mailing Address - Country:US
Mailing Address - Phone:406-522-7488
Mailing Address - Fax:406-522-7487
Practice Address - Street 1:3745 HARRISON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6808
Practice Address - Country:US
Practice Address - Phone:406-494-7050
Practice Address - Fax:406-494-1424
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PFTMP-12985225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist