Healthcare Provider Details

I. General information

NPI: 1427128495
Provider Name (Legal Business Name): POWELL COUNTY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MARYLAND AVE
DEER LODGE MT
59722-1806
US

IV. Provider business mailing address

1101 MARYLAND AVE
DEER LODGE MT
59722-1806
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-1991
  • Fax: 406-846-1347
Mailing address:
  • Phone: 406-846-1991
  • Fax: 406-846-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH P. MCGILLIS
Title or Position: OWNER
Credential: P.T.
Phone: 406-846-1991