Healthcare Provider Details

I. General information

NPI: 1730912684
Provider Name (Legal Business Name): CORE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 WHITEFISH STAGE
KALISPELL MT
59901-2735
US

IV. Provider business mailing address

1077 WHITEFISH STAGE
KALISPELL MT
59901-2735
US

V. Phone/Fax

Practice location:
  • Phone: 406-270-2225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN STOCKHAM-BALLER
Title or Position: OWNER, PHYSICAL THERAPIST
Credential:
Phone: 406-270-2225