Healthcare Provider Details

I. General information

NPI: 1902976749
Provider Name (Legal Business Name): ORTHOPEDIC REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/28/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HERITAGE WAY
KALISPELL MT
59901-3100
US

IV. Provider business mailing address

25 HERITAGE WAY
KALISPELL MT
59901-3100
US

V. Phone/Fax

Practice location:
  • Phone: 406-407-7990
  • Fax: 406-260-4084
Mailing address:
  • Phone: 406-407-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: PATRICK A GULICK
Title or Position: OWNER
Credential: PT
Phone: 406-407-7990