Provider Demographics
NPI:1598847444
Name:BOERSMA, JOHN C (MPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BOERSMA
Suffix:
Gender:M
Credentials:MPT
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 160431
Mailing Address - Street 2:
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-0431
Mailing Address - Country:US
Mailing Address - Phone:406-995-7525
Mailing Address - Fax:406-995-7528
Practice Address - Street 1:495 LITTLE COYOTE RD
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716
Practice Address - Country:US
Practice Address - Phone:406-995-7525
Practice Address - Fax:406-995-7528
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1638PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000061408OtherBLUE CROSS BLUE SHEILD
MT3402261Medicaid
MT3402261Medicaid