Healthcare Provider Details

I. General information

NPI: 1699235564
Provider Name (Legal Business Name): PELVIS SPINE & SPORT PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MAIN ST STE C
KALISPELL MT
59901-4448
US

IV. Provider business mailing address

35 MAIN ST STE C
KALISPELL MT
59901-4448
US

V. Phone/Fax

Practice location:
  • Phone: 406-471-0464
  • Fax: 406-260-4796
Mailing address:
  • Phone: 406-471-0464
  • Fax: 406-260-4796

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: MARY H DIXON
Title or Position: PRACTICE OWNER
Credential: DPT
Phone: 406-471-0464