Provider Demographics
NPI:1699125641
Name:HALVORSON, JUSTIN (ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HALVORSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 SILVERBOW AVE
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-4222
Mailing Address - Country:US
Mailing Address - Phone:406-599-2117
Mailing Address - Fax:
Practice Address - Street 1:903 SILVERBOW AVE
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-4222
Practice Address - Country:US
Practice Address - Phone:406-599-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer