Provider Demographics
NPI:1932170917
Name:RUSDAL, CHRISTY M (MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:M
Last Name:RUSDAL
Suffix:
Gender:F
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:M
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, ATC, CSCS
Mailing Address - Street 1:25 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3100
Mailing Address - Country:US
Mailing Address - Phone:406-407-7990
Mailing Address - Fax:855-928-0774
Practice Address - Street 1:419 W 9TH ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1766
Practice Address - Country:US
Practice Address - Phone:406-293-8942
Practice Address - Fax:406-293-4708
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1448225100000X, 2251S0007X, 2251X0800X, 2251P0200X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMSF1140263OtherMONTANA STATE FUND
MT0168677OtherWAWC
MT0345219Medicaid
MT841391220006OtherEBMS
MT000062026OtherBCBS
MT000062026OtherBCBS
MT000005955Medicare ID - Type Unspecified