Healthcare Provider Details

I. General information

NPI: 1396662755
Provider Name (Legal Business Name): COHO PHYSICAL THERAPY AND PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W IDAHO ST STE 200
KALISPELL MT
59901-3942
US

IV. Provider business mailing address

315 W IDAHO ST STE 200
KALISPELL MT
59901-3942
US

V. Phone/Fax

Practice location:
  • Phone: 406-471-4173
  • Fax:
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 State

VIII. Authorized Official

Name: MATTHEW CRONK
Title or Position: OWNER
Credential: PT, DPT
Phone: 406-471-4173