Provider Demographics
NPI:1689997306
Name:SCALISE, MICHAEL A (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SCALISE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 SOUTH AVE W
Mailing Address - Street 2:THERAPY DEP
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-6405
Mailing Address - Country:US
Mailing Address - Phone:406-626-0400
Mailing Address - Fax:
Practice Address - Street 1:2651 SOUTH AVE W
Practice Address - Street 2:THERAPY DEP
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-6405
Practice Address - Country:US
Practice Address - Phone:406-626-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist