Provider Demographics
NPI:1396802948
Name:SATHER-HEYNE, CARLY J (MPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:J
Last Name:SATHER-HEYNE
Suffix:
Gender:F
Credentials:MPT
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 4985
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-4985
Mailing Address - Country:US
Mailing Address - Phone:406-261-5840
Mailing Address - Fax:406-862-2112
Practice Address - Street 1:576 SPOKANE AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2781
Practice Address - Country:US
Practice Address - Phone:406-261-5840
Practice Address - Fax:406-862-2112
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3401292Medicaid
MT60713OtherBC&BS