Provider Demographics
NPI:1598770166
Name:MACROW, KELLY LYNN (DPT)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:MACROW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26815 BLIXIT CREEK RD
Mailing Address - Street 2:POTOMAC
Mailing Address - City:BONNER
Mailing Address - State:MT
Mailing Address - Zip Code:59823-9672
Mailing Address - Country:US
Mailing Address - Phone:406-244-0925
Mailing Address - Fax:
Practice Address - Street 1:SCHOOL OF PT AND REHAB SERVICES
Practice Address - Street 2:SKAGGS BUILDING 025
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-0001
Practice Address - Country:US
Practice Address - Phone:406-243-4016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist