MEDICARE: GRAHAM GAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT297421	CA

General Provider Information

NPI Number	:	1093379091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRAHAM GAGE

Provider Business Mailing Address
First Line	:	5000 BLUE MOUNTAIN RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-9213
Country	:	US
Telephone Number	:	406-251-2323
Fax Number	:	406-251-2999

Provider Business Practice Location Address
First Line	:	150 E SPRUCE ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4504
Country	:	US
Telephone Number	:	406-251-2323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	01/07/2026

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Directions to “ GRAHAM GAGE ” Practice Location

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