Provider Demographics
NPI:1720553597
Name:LOSOS, SETH (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:
Last Name:LOSOS
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SAWYER LN APT F
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9096
Mailing Address - Country:US
Mailing Address - Phone:701-425-5151
Mailing Address - Fax:
Practice Address - Street 1:850 HOLT DR
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6218
Practice Address - Country:US
Practice Address - Phone:406-837-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2529225100000X
MN12946225100000X
2255A2300X
MTPTP-PT-COM-JP-27111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty