Provider Demographics
NPI:1760961221
Name:RICHARDS, JAIMEE ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:JAIMEE
Middle Name:ROSE
Last Name:RICHARDS
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 1:524 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1929
Mailing Address - Country:US
Mailing Address - Phone:406-782-4748
Mailing Address - Fax:406-782-4375
Practice Address - Street 1:524 E PARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1929
Practice Address - Country:US
Practice Address - Phone:406-782-4748
Practice Address - Fax:406-782-4375
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT15078OtherMONTANA STATE LICENSE