Provider Demographics
NPI:1215667431
Name:KLEINDL, THEODORA B
Entity type:Individual
Prefix:
First Name:THEODORA
Middle Name:B
Last Name:KLEINDL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4431
Mailing Address - Country:US
Mailing Address - Phone:406-404-9740
Mailing Address - Fax:
Practice Address - Street 1:401 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4431
Practice Address - Country:US
Practice Address - Phone:406-404-9740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program