Provider Demographics
NPI:1356545966
Name:SOULIA, ANA DUPOIS (DPT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:DUPOIS
Last Name:SOULIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:NICOLE
Other - Last Name:DUPUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5000 BLUE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9213
Mailing Address - Country:US
Mailing Address - Phone:406-251-2323
Mailing Address - Fax:406-251-2999
Practice Address - Street 1:150 E SPRUCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4504
Practice Address - Country:US
Practice Address - Phone:406-549-0064
Practice Address - Fax:406-543-2999
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5024225100000X
MT7545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR845868008OtherBCBS
M011004723Medicare PIN
ORR147237Medicare PIN