Healthcare Provider Details

I. General information

NPI: 1124180468
Provider Name (Legal Business Name): THE LAZY MS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 7TH AVE S STE C3
GREAT FALLS MT
59405-3031
US

IV. Provider business mailing address

2509 7TH AVE S STE C3
GREAT FALLS MT
59405-3031
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-7800
  • Fax: 406-771-6883
Mailing address:
  • Phone: 406-771-7800
  • Fax: 406-771-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1660PT
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1660PT
License Number StateMT

VIII. Authorized Official

Name: ALFRED GUY EDWARDS
Title or Position: DIRECTOR
Credential: PT
Phone: 406-771-7800