Provider Demographics
NPI:1790773133
Name:HUMPAL FISHER, MELISSA JEAN (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JEAN
Last Name:HUMPAL FISHER
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:14 W CLARA CT
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7687
Mailing Address - Country:US
Mailing Address - Phone:406-579-3695
Mailing Address - Fax:
Practice Address - Street 1:536 S COTTONWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9515
Practice Address - Country:US
Practice Address - Phone:406-586-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer