Provider Demographics
NPI:1235129248
Name:HEUISER, BRIAN J (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:HEUISER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:731 N EWING ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3606
Mailing Address - Country:US
Mailing Address - Phone:406-457-0969
Mailing Address - Fax:406-449-0516
Practice Address - Street 1:3180 DREDGE DR
Practice Address - Street 2:STE F
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0561
Practice Address - Country:US
Practice Address - Phone:406-449-0654
Practice Address - Fax:406-449-0516
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1416208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0003400901Medicaid
MT0003400901Medicaid