Healthcare Provider Details

I. General information

NPI: 1073021093
Provider Name (Legal Business Name): BIG STONE THERAPIES MONTAGUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 WATER ST
MONTAGUE MI
49437-9206
US

IV. Provider business mailing address

500 CROSS ST
BIG STONE CITY SD
57216-8237
US

V. Phone/Fax

Practice location:
  • Phone: 231-893-6655
  • Fax: 231-893-4902
Mailing address:
  • Phone: 605-541-1140
  • Fax: 605-541-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE ACKERMAN
Title or Position: VP FINANCE AND ADMIN
Credential:
Phone: 605-541-1144