Healthcare Provider Details

I. General information

NPI: 1902572472
Provider Name (Legal Business Name): EMPOWER PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 RAWLINGS RD
LIBBY MT
59923-8918
US

IV. Provider business mailing address

145 RAWLINGS RD
LIBBY MT
59923-8918
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-7021
  • Fax:
Mailing address:
  • Phone: 406-293-7021
  • 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: DR. NICHOLAS A PETERSON
Title or Position: PHYSICAL THERAPIST / OWNER
Credential: PT, DPT
Phone: 406-293-7021