Basic Information
| Provider Information | |||||||||
| NPI: | 1295981074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHELS | ||||||||
| FirstName: | SURRENA | ||||||||
| MiddleName: | KATE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAVIDSON | ||||||||
| OtherFirstName: | SURRENA | ||||||||
| OtherMiddleName: | KATE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 50 27TH ST W | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591028601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066519099 | ||||||||
| FaxNumber: | 4066514332 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 27TH ST W | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591028601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066519099 | ||||||||
| FaxNumber: | 4066514332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 08/13/2008 | ||||||||
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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 | 225100000X | 2136PT | MT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.