Healthcare Provider Details

I. General information

NPI: 1225114903
Provider Name (Legal Business Name): EDGE PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 25TH ST N SUITE 200
GREAT FALLS MT
59401-1381
US

IV. Provider business mailing address

1000 25TH ST N SUITE 200
GREAT FALLS MT
59401-1381
US

V. Phone/Fax

Practice location:
  • Phone: 406-453-5555
  • Fax: 406-453-0879
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAWRANCE W MCAFEE
Title or Position: CFO
Credential:
Phone: 713-297-7000