Provider Demographics
NPI:1841540622
Name:MCNULTY, STEPHANIE LISA (PT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LISA
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-300-1612
Practice Address - Street 1:103 WHITEWATER PL STE D
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-4502
Practice Address - Country:US
Practice Address - Phone:406-883-8101
Practice Address - Fax:406-883-8102
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009286225100000X
SC5829225100000X
MTPTP-PT-LIC-9391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist