Healthcare Provider Details

I. General information

NPI: 1669535928
Provider Name (Legal Business Name): VOGELZANG PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W BROADWAY ST STE C
MISSOULA MT
59808-1825
US

IV. Provider business mailing address

1900 W BROADWAY ST STE C
MISSOULA MT
59808-1825
US

V. Phone/Fax

Practice location:
  • Phone: 406-544-5679
  • Fax:
Mailing address:
  • Phone: 406-544-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1576PT
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1576PT
License Number StateMT

VIII. Authorized Official

Name: KEVIN VOGELZANG
Title or Position: OWNER
Credential: PT
Phone: 406-544-5679