Basic Information
| Provider Information | |||||||||
| NPI: | 1225317324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRANCOM | ||||||||
| FirstName: | CAROL | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 893 E 3200 N | ||||||||
| Address2: | |||||||||
| City: | PRESTON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087058263 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 14TH AVE W | ||||||||
| Address2: | |||||||||
| City: | POLSON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598605321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068834378 | ||||||||
| FaxNumber: | 4068830039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2011 | ||||||||
| LastUpdateDate: | 08/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA-2257 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 7585727-2402 | UT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.