Healthcare Provider Details

I. General information

NPI: 1558063008
Provider Name (Legal Business Name): MISSION MOBILE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37053 BAPTISTE RD
RONAN MT
59864-8610
US

IV. Provider business mailing address

37053 BAPTISTE RD
RONAN MT
59864-8610
US

V. Phone/Fax

Practice location:
  • Phone: 406-273-8110
  • Fax: 406-303-2023
Mailing address:
  • Phone: 406-273-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BONNIE WEIJOHN
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-273-8110