Individual
MR. DANIEL A GULLOTTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.,M.A.
Contact information
Practice address
211A MAIN ST, POLSON, MT 59860-2119
(406) 883-8101
(406) 883-8102
Mailing address
211A MAIN ST, POLSON, MT 59860-2119
(406) 883-8101
(406) 883-8102
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
741PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0342244
—
MT
05
—
0348556
—
MT
01
—
061605
LPT BCBS
MT
01
—
062065
PPT BC/BS
MT
01
—
650018165
RAILROAD MEDICARE
MT
Enumeration date
07/28/2005
Last updated
07/23/2009
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