Provider Demographics
NPI:1174799266
Name:MITMAN, JOHN JAY (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAY
Last Name:MITMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 TAMMANY LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-9216
Mailing Address - Country:US
Mailing Address - Phone:406-363-2816
Mailing Address - Fax:406-363-2816
Practice Address - Street 1:472 TAMMANY LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-9216
Practice Address - Country:US
Practice Address - Phone:406-363-2816
Practice Address - Fax:406-363-2816
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT733225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports