Provider Demographics
NPI:1629405261
Name:GARRE, MICHAEL JASON (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:GARRE
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 1:606 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3469
Mailing Address - Country:US
Mailing Address - Phone:406-599-9895
Mailing Address - Fax:
Practice Address - Street 1:1043 STONERIDGE DR
Practice Address - Street 2:#1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7084
Practice Address - Country:US
Practice Address - Phone:406-586-2283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-5940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist