Provider Demographics
NPI:1366813776
Name:WOLSTEIN, CARLY HILLEY (DPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:HILLEY
Last Name:WOLSTEIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 HOLT DR
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-6218
Mailing Address - Country:US
Mailing Address - Phone:406-837-3255
Mailing Address - Fax:406-837-3256
Practice Address - Street 1:850 HOLT DR
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-6218
Practice Address - Country:US
Practice Address - Phone:406-837-3255
Practice Address - Fax:406-837-3256
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist