Provider Demographics
NPI:1982137121
Name:CARLILE, MICHELLE RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:CARLILE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 AVENUE E STE A
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2943
Mailing Address - Country:US
Mailing Address - Phone:406-690-6996
Mailing Address - Fax:406-206-5262
Practice Address - Street 1:1701 AVENUE E STE A
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-690-6996
Practice Address - Fax:406-206-5262
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45672251P0200X
MT171552251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTPTP-PT-LIC-17155OtherMONTANA STATE