Provider Demographics
NPI:1124841242
Name:BURTSFIELD, ROCKY LEE
Entity type:Individual
Prefix:
First Name:ROCKY
Middle Name:LEE
Last Name:BURTSFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 EZY DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9296
Mailing Address - Country:US
Mailing Address - Phone:406-253-3066
Mailing Address - Fax:
Practice Address - Street 1:427 EZY DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-9296
Practice Address - Country:US
Practice Address - Phone:406-253-3066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0809919604118347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle