Provider Demographics
NPI:1821056060
Name:HALVERSON, SETH D (PT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:D
Last Name:HALVERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 N 14TH
Mailing Address - Street 2:UNIT A
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-586-4678
Mailing Address - Fax:406-586-4670
Practice Address - Street 1:1419 N 14TH
Practice Address - Street 2:UNIT A
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-586-4678
Practice Address - Fax:406-586-4670
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT201386522597150000OtherTRICARE
MT60573OtherBLUE CROSS BLUE SHIELD
MT1245701OtherMONTANA STATE FUND
MT3400995Medicaid