Provider Demographics
NPI:1871574657
Name:SIEGEL, NANCY J (MS PT, RCST)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:MS PT, RCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-5240
Mailing Address - Country:US
Mailing Address - Phone:406-544-9474
Mailing Address - Fax:
Practice Address - Street 1:4604 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-5240
Practice Address - Country:US
Practice Address - Phone:406-544-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT61876OtherBCBS
MTMSF1157182OtherMT STATE FUND WORK COMP
MT3401445Medicaid