Provider Demographics
NPI:1740595115
Name:ILES, MARIA CHRISTINE (DPT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CHRISTINE
Last Name:ILES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8726
Mailing Address - Country:US
Mailing Address - Phone:406-541-8778
Mailing Address - Fax:406-541-8780
Practice Address - Street 1:220 BENTON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8726
Practice Address - Country:US
Practice Address - Phone:605-670-1985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist