Basic Information
| Provider Information | |||||||||
| NPI: | 1104187574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEPNER | ||||||||
| FirstName: | ERICA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1343 US HIGHWAY 93 N | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599179503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062973915 | ||||||||
| FaxNumber: | 4062973919 | ||||||||
| Practice Location | |||||||||
| Address1: | 1343 US HIGHWAY 93 N | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599179503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062973915 | ||||||||
| FaxNumber: | 4062973364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2012 | ||||||||
| LastUpdateDate: | 07/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4383 | MT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1104187574 | 05 | MT | MEDICAID |