Healthcare Provider Details

I. General information

NPI: 1992666945
Provider Name (Legal Business Name): TRAILHEAD PHYSICAL THERAPY AND PERFORMANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N N ST
LIVINGSTON MT
59047-2826
US

IV. Provider business mailing address

1001 S MAIN ST STE 600
KALISPELL MT
59901-1498
US

V. Phone/Fax

Practice location:
  • Phone: 406-219-8017
  • Fax:
Mailing address:
  • Phone: 406-219-8017
  • 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: ETHAN GRIFFEL
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 406-219-8017