Provider Demographics
NPI:1942462270
Name:BERUBE, DULCINEA A (MSPT)
Entity Type:Individual
Prefix:
First Name:DULCINEA
Middle Name:A
Last Name:BERUBE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:DULCINEA
Other - Middle Name:A
Other - Last Name:VOERMANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-2828
Mailing Address - Country:US
Mailing Address - Phone:406-897-2404
Mailing Address - Fax:406-897-2357
Practice Address - Street 1:39 6TH ST W UNIT C
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-3602
Practice Address - Country:US
Practice Address - Phone:406-897-2404
Practice Address - Fax:406-897-2357
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1942462270Medicaid