Provider Demographics
NPI:1386974095
Name:VINGLAS, KEBRINA NICHOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KEBRINA
Middle Name:NICHOLE
Last Name:VINGLAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KEBRINA
Other - Middle Name:NICHOLE
Other - Last Name:MARTELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:802 SUMMER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-7781
Mailing Address - Country:US
Mailing Address - Phone:406-600-4822
Mailing Address - Fax:406-586-5694
Practice Address - Street 1:1532 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8808
Practice Address - Country:US
Practice Address - Phone:406-586-5694
Practice Address - Fax:406-586-5694
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2210PT2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic