Individual
MICHAEL JON CLOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
850 HOLT DRIVE, BIGFORK, MT 59911
(406) 837-6892
(406) 837-6435
Mailing address
PO BOX 1527, BIGFORK, MT 59911-1527
(406) 837-6892
(406) 837-6435
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1350PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000345185
—
MT
01
—
61996
BCBS OF MONTANA PROVIDER
MT
Enumeration date
12/29/2006
Last updated
10/30/2007
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