Healthcare Provider Details

I. General information

NPI: 1356522833
Provider Name (Legal Business Name): MOUNTAIN VIEW PHYSICAL THERAPY AND SPORTS INJURY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 1ST AVE N
GREAT FALLS MT
59401-2506
US

IV. Provider business mailing address

314 1ST AVE N
GREAT FALLS MT
59401-2506
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-0438
  • Fax: 406-727-8550
Mailing address:
  • Phone: 406-454-0438
  • Fax: 406-727-8550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMT

VIII. Authorized Official

Name: MS. MITCH D MOLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 406-454-0438