Provider Demographics
NPI:1023485687
Name:MAPHIS, MICHAELA (DPT)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:MAPHIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:O'DORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1200 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3975 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6474
Practice Address - Country:US
Practice Address - Phone:406-777-6002
Practice Address - Fax:406-206-2965
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-14959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT200030833Medicaid