Individual
JESSE TAE DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 32ND ST S, GREAT FALLS, MT 59405-5300
(406) 761-4300
Mailing address
1501 SPRUCE CT, GREAT FALLS, MT 59405-6205
(406) 788-2310
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTP-PTA--LIC-8123
MT
Other
Enumeration date
03/13/2023
Last updated
03/13/2023
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