Healthcare Provider Details

I. General information

NPI: 1962532846
Provider Name (Legal Business Name): MONTANA SPINE & JOINT REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 COLONIAL DR SUITE A
HELENA MT
59601-4947
US

IV. Provider business mailing address

2748 COLONIAL DR SUITE A
HELENA MT
59601-4947
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-1122
  • Fax: 406-443-1144
Mailing address:
  • Phone: 406-443-1122
  • Fax: 406-443-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMT1243
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberMT1481
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberMT1068
License Number StateMT

VIII. Authorized Official

Name: SHERRI E GOMES
Title or Position: VICE PRESIDENT/SHAREHOLDER
Credential:
Phone: 406-443-1122