Individual
STACIA WYNNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3131 AMHERST AVE, BUTTE, MT 59701-4653
(406) 494-7035
Mailing address
3131 AMHERST AVE, BUTTE, MT 59701-4653
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2456
MT
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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