Healthcare Provider Details

I. General information

NPI: 1568946291
Provider Name (Legal Business Name): BUILD PHYSIO & PERFORMANCE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 PRONGHORN TRAIL
BOZEMAN MT
59718
US

IV. Provider business mailing address

609 PRONGHORN TRL STE C
BOZEMAN MT
59718-7090
US

V. Phone/Fax

Practice location:
  • Phone: 406-580-0803
  • Fax: 406-258-0580
Mailing address:
  • Phone: 406-580-0803
  • Fax: 406-258-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA OPSTEDAL
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 406-580-0803