Provider Demographics
NPI:1689849044
Name:MATTSON, URSULA (PT)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:MATTSON
Suffix:
Gender:F
Credentials:PT
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 256
Mailing Address - Street 2:
Mailing Address - City:EAST GLACIER PARK
Mailing Address - State:MT
Mailing Address - Zip Code:59434-0256
Mailing Address - Country:US
Mailing Address - Phone:406-226-4451
Mailing Address - Fax:
Practice Address - Street 1:820 2ND ST W
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3476
Practice Address - Country:US
Practice Address - Phone:406-265-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist