Provider Demographics
NPI:1790891331
Name:MICHALSON, ANDI LOUISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANDI
Middle Name:LOUISE
Last Name:MICHALSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ANDI
Other - Middle Name:LOUISE
Other - Last Name:FEHRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3955 TOPAZ CT
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-6041
Mailing Address - Country:US
Mailing Address - Phone:406-459-2172
Mailing Address - Fax:406-449-0516
Practice Address - Street 1:3180 DREDGE DR
Practice Address - Street 2:STE. F
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0561
Practice Address - Country:US
Practice Address - Phone:406-449-0654
Practice Address - Fax:406-449-0516
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0035308Medicaid
MT0035308Medicaid