Provider Demographics
NPI:1740807544
Name:LODATO, BAILEY AMBER (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:AMBER
Last Name:LODATO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:BAILEY
Other - Middle Name:AMBER
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1705 BOW ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5652
Mailing Address - Country:US
Mailing Address - Phone:406-549-5283
Mailing Address - Fax:
Practice Address - Street 1:1705 BOW ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5652
Practice Address - Country:US
Practice Address - Phone:406-549-5283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-29
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist