Provider Demographics
NPI:1457453961
Name:STENSON, KEVIN M (PT, MS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:STENSON
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1929
Mailing Address - Country:US
Mailing Address - Phone:406-782-4748
Mailing Address - Fax:406-782-4375
Practice Address - Street 1:524 E PARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1929
Practice Address - Country:US
Practice Address - Phone:406-782-4748
Practice Address - Fax:406-782-4375
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1671PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60653OtherBLUE CROSS BLUE SHIELD
MT3401099Medicaid
MT60653OtherBLUE CROSS BLUE SHIELD