Healthcare Provider Details

I. General information

NPI: 1801092366
Provider Name (Legal Business Name): ELEMENT PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 DIXON AVE STE A
MISSOULA MT
59801-8219
US

IV. Provider business mailing address

2455 DIXON AVE STE A
MISSOULA MT
59801-8219
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-7860
  • Fax: 406-543-7862
Mailing address:
  • Phone: 406-543-7860
  • Fax: 406-543-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number1300PT
License Number StateMT

VIII. Authorized Official

Name: MARLA DIANE CRAGO
Title or Position: OWNER
Credential: PT
Phone: 406-543-7860