Healthcare Provider Details

I. General information

NPI: 1235673708
Provider Name (Legal Business Name): LONE PEAK PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2016
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W MAIN ST STE 1
BELGRADE MT
59714-3836
US

IV. Provider business mailing address

PO BOX 11629
BOZEMAN MT
59719-1629
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-2235
  • Fax: 406-388-2281
Mailing address:
  • Phone: 406-522-7488
  • Fax: 406-522-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOHN C BOERSMA
Title or Position: OWNER/PRESIDENT
Credential: MPT, OCS
Phone: 406-522-7488