Individual
URSULA ANNA DIETERLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
#8 MISSION DRIVE, ST IGNATIUS, MT 59865
(406) 745-2525
(406) 745-4233
Mailing address
P.O. BOX 880, MISSION DRIVE, ST IGNATIUS, MT 59865
(406) 745-3525
(406) 745-4233
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
394PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03-01605-2
STATE FUND
MT
05
—
341598
—
MT
01
—
60416
BCBS
MT
Enumeration date
09/08/2006
Last updated
07/16/2009
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