Provider Demographics
NPI:1639279219
Name:VAIL, JULIETTE (RPT)
Entity type:Individual
Prefix:
First Name:JULIETTE
Middle Name:
Last Name:VAIL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:VAIL
Other - Middle Name:
Other - Last Name:PHYSICAL THERAPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1762
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-1762
Mailing Address - Country:US
Mailing Address - Phone:406-539-5393
Mailing Address - Fax:406-585-0032
Practice Address - Street 1:316 E BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4710
Practice Address - Country:US
Practice Address - Phone:406-539-5393
Practice Address - Fax:406-585-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist