Healthcare Provider Details

I. General information

NPI: 1891080529
Provider Name (Legal Business Name): CORVALLIS PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 EASTSIDE HWY
CORVALLIS MT
59828
US

IV. Provider business mailing address

336 FAIRGROUNDS RD
HAMILTON MT
59840
US

V. Phone/Fax

Practice location:
  • Phone: 406-961-3914
  • Fax: 406-363-5271
Mailing address:
  • Phone: 406-375-0980
  • Fax: 406-375-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMT

VIII. Authorized Official

Name: MR. DOUGLAS J MARTIN
Title or Position: PRESIDENT
Credential: MPT
Phone: 406-375-0980