Provider Demographics
NPI:1649453697
Name:DEAN, CINDY JO
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:JO
Last Name:DEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VETERANS DRIVE
Mailing Address - Street 2:P.O. BOX 250
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-0250
Mailing Address - Country:US
Mailing Address - Phone:406-892-3256
Mailing Address - Fax:406-892-0143
Practice Address - Street 1:400 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-0250
Practice Address - Country:US
Practice Address - Phone:406-892-3256
Practice Address - Fax:406-892-0143
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1518225100000X
WAPT00009640225100000X
MT769225X00000X
WAOT00001701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist