Provider Demographics
NPI:1679688840
Name:KUIPERS, JUDITH ELLEN (PT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELLEN
Last Name:KUIPERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:ELLEN
Other - Last Name:DEWIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1313 W PARK STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047
Mailing Address - Country:US
Mailing Address - Phone:406-222-5519
Mailing Address - Fax:406-222-0366
Practice Address - Street 1:1313 W PARK STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047
Practice Address - Country:US
Practice Address - Phone:406-222-5519
Practice Address - Fax:406-222-0366
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMSF1140903OtherMT STATE FUND
MT60530OtherBLUE CROSS BLUE SHIELD
MT344522Medicaid