Provider Demographics
NPI:1124065776
Name:HAIDLE, FRANK ROBIN (PT)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:ROBIN
Last Name:HAIDLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:HAIDLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1456
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-1456
Mailing Address - Country:US
Mailing Address - Phone:406-297-3915
Mailing Address - Fax:406-297-3364
Practice Address - Street 1:1343 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9503
Practice Address - Country:US
Practice Address - Phone:406-297-3915
Practice Address - Fax:406-297-3364
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT783PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1124065776Medicaid
MT1124065776OtherBCBS
000082772Medicare PIN