Provider Demographics
NPI:1699392027
Name:KALBFLEISCH, JACE MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:JACE
Middle Name:MATTHEW
Last Name:KALBFLEISCH
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 1:482 OLD CORVALLIS RD
Mailing Address - Street 2:STE A
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840
Mailing Address - Country:US
Mailing Address - Phone:406-381-3683
Mailing Address - Fax:
Practice Address - Street 1:482 OLD CORVALLIS RD
Practice Address - Street 2:STE A
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3129
Practice Address - Country:US
Practice Address - Phone:406-381-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1699392027Medicaid