Provider Demographics
NPI:1972847473
Name:MATTSON, KERRY KAYE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:KAYE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 2100 RD S
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MT
Mailing Address - Zip Code:59522-7727
Mailing Address - Country:US
Mailing Address - Phone:406-370-2954
Mailing Address - Fax:
Practice Address - Street 1:315 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MT
Practice Address - Zip Code:59522
Practice Address - Country:US
Practice Address - Phone:406-759-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2086225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant