Healthcare Provider Details

I. General information

NPI: 1548152796
Provider Name (Legal Business Name): ABUNDANT LIFE PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 OLD CORVALLIS RD STE Y
HAMILTON MT
59840-3213
US

IV. Provider business mailing address

274 OLD CORVALLIS RD STE Y
HAMILTON MT
59840-3213
US

V. Phone/Fax

Practice location:
  • Phone: 406-916-2588
  • Fax:
Mailing address:
  • Phone: 406-916-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHLEY PALACIO
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 303-884-5508