Healthcare Provider Details

I. General information

NPI: 1558679712
Provider Name (Legal Business Name): NORTHERN ROCKIES PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 SOUTH AVE W STE 101
MISSOULA MT
59804-5137
US

IV. Provider business mailing address

2740 SOUTH AVE W STE 101
MISSOULA MT
59804-5137
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-0617
  • Fax: 406-728-1085
Mailing address:
  • Phone: 406-543-0617
  • Fax: 406-728-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN JACOBSON
Title or Position: MANAGING PARTNER
Credential:
Phone: 406-728-6101