Healthcare Provider Details

I. General information

NPI: 1942086871
Provider Name (Legal Business Name): KC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 CLEVELAND ROAD
BIG SANDY MT
59520
US

IV. Provider business mailing address

PO BOX 1246
BIG SANDY MT
59520-1246
US

V. Phone/Fax

Practice location:
  • Phone: 406-378-2655
  • Fax:
Mailing address:
  • Phone: 406-378-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. KURTIS LEE STRUTZ
Title or Position: PRESIDENT
Credential: MPT
Phone: 406-378-2655