Provider Demographics
NPI:1053522680
Name:POLEQUAPTEWA, HONANI (PT, MPT, CEEAA, LMT)
Entity type:Individual
Prefix:MR
First Name:HONANI
Middle Name:
Last Name:POLEQUAPTEWA
Suffix:
Gender:M
Credentials:PT, MPT, CEEAA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-0447
Mailing Address - Country:US
Mailing Address - Phone:406-827-8050
Mailing Address - Fax:
Practice Address - Street 1:91 CAMPUS DR
Practice Address - Street 2:PMB 1217
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4492
Practice Address - Country:US
Practice Address - Phone:406-827-3659
Practice Address - Fax:406-549-3115
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist