Healthcare Provider Details

I. General information

NPI: 1588848956
Provider Name (Legal Business Name): GRANITE PHYSICAL THERAPY & SPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N STE 140W
BILLINGS MT
59101-7507
US

IV. Provider business mailing address

3838 AVENUE B STE B
BILLINGS MT
59102-7550
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5050
  • Fax:
Mailing address:
  • Phone: 406-238-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GREGORY MCDOWELL
Title or Position: PRESIDENT
Credential: MD
Phone: 406-237-5050