Healthcare Provider Details

I. General information

NPI: 1659600203
Provider Name (Legal Business Name): CLEARWATER THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E OAK ST STE 1A
BOZEMAN MT
59715-2977
US

IV. Provider business mailing address

117 E OAK ST STE 1A
BOZEMAN MT
59715-2977
US

V. Phone/Fax

Practice location:
  • Phone: 406-585-3701
  • Fax: 406-586-9708
Mailing address:
  • Phone: 406-585-3701
  • Fax: 406-586-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1861
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberMT1861
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberMT2360
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberMT2289
License Number StateMT

VIII. Authorized Official

Name: JORDEN BORDER
Title or Position: OFFICE ADMIN
Credential:
Phone: 406-585-3701