Provider Demographics
NPI:1801874870
Name:COBLE, GRETCHEN M HIESTERMAN (PT)
Entity type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:M HIESTERMAN
Last Name:COBLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:MARIE
Other - Last Name:HIESTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:251 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601
Mailing Address - Country:US
Mailing Address - Phone:406-457-0480
Mailing Address - Fax:406-457-0481
Practice Address - Street 1:251 SADDLE DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-457-0480
Practice Address - Fax:406-457-0481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1004225100000X
OR3076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401112Medicaid