Provider Demographics
NPI:1821165127
Name:WILTZEN, STEPHEN LEE (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LEE
Last Name:WILTZEN
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 1:851 BRIDGER DRIVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1803
Mailing Address - Country:US
Mailing Address - Phone:406-586-7288
Mailing Address - Fax:406-586-0219
Practice Address - Street 1:851 BRIDGER DRIVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1803
Practice Address - Country:US
Practice Address - Phone:406-586-7288
Practice Address - Fax:406-586-0219
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT94 PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist