Provider Demographics
NPI:1962993139
Name:GRIFFEL, ETHAN EARL (DPT)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:EARL
Last Name:GRIFFEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1498
Mailing Address - Country:US
Mailing Address - Phone:406-219-8017
Mailing Address - Fax:
Practice Address - Street 1:103 N N ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2826
Practice Address - Country:US
Practice Address - Phone:208-317-0287
Practice Address - Fax:208-317-0287
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist