Healthcare Provider Details

I. General information

NPI: 1780854927
Provider Name (Legal Business Name): DEER LODGE VALLEY THERAPY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MAIN ST
DEER LODGE MT
59722-1057
US

IV. Provider business mailing address

310 MAIN ST
DEER LODGE MT
59722-1057
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-3448
  • Fax: 408-846-2298
Mailing address:
  • Phone: 406-846-3448
  • Fax: 408-846-2298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMT131
License Number StateMT

VIII. Authorized Official

Name: MRS. DONNA N MCCATHY
Title or Position: OWNER
Credential: P.T.
Phone: 406-846-3448