Provider Demographics
NPI:1629098629
Name:KAY, CHAD D (MSPT, CSCS)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:D
Last Name:KAY
Suffix:
Gender:M
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 SOUTH AVE W
Mailing Address - Street 2:STE 101
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-5114
Mailing Address - Country:US
Mailing Address - Phone:406-543-0617
Mailing Address - Fax:406-728-1085
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7401
Practice Address - Country:US
Practice Address - Phone:406-543-0617
Practice Address - Fax:406-728-1085
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X
MTPTP-PT-LIC-1415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3402193Medicaid