Provider Demographics
NPI:1366055097
Name:STIFFARM, MARIAH NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:NICOLE
Last Name:STIFFARM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-1289
Mailing Address - Country:US
Mailing Address - Phone:406-338-7912
Mailing Address - Fax:406-338-7919
Practice Address - Street 1:503 POPIMI ST
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-5315
Practice Address - Country:US
Practice Address - Phone:406-338-7912
Practice Address - Fax:406-338-7919
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTPPTLIC1930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist