Healthcare Provider Details

I. General information

NPI: 1891849022
Provider Name (Legal Business Name): LONE PEAK PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 TOWN CENTER AVE
BIG SKY MT
59716
US

IV. Provider business mailing address

PO BOX 11629
BOZEMAN MT
59719-1629
US

V. Phone/Fax

Practice location:
  • Phone: 406-995-7525
  • Fax: 406-995-7528
Mailing address:
  • Phone: 406-522-7488
  • Fax: 406-522-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOHN C BOERSMA
Title or Position: OWNER
Credential: MPT
Phone: 406-995-7525