Provider Demographics
NPI:1285348649
Name:MATTICK, DANITA JO (DPT)
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:JO
Last Name:MATTICK
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 1:6333 BELLEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-8442
Mailing Address - Country:US
Mailing Address - Phone:406-600-4806
Mailing Address - Fax:
Practice Address - Street 1:2632 CATRON ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4185
Practice Address - Country:US
Practice Address - Phone:866-746-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic