Healthcare Provider Details

I. General information

NPI: 1922728062
Provider Name (Legal Business Name): 406 ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 S CENTRAL AVE STE B
SIDNEY MT
59270-4126
US

IV. Provider business mailing address

216 S CENTRAL AVE STE B
SIDNEY MT
59270-4126
US

V. Phone/Fax

Practice location:
  • Phone: 406-478-7769
  • Fax:
Mailing address:
  • Phone:
  • 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: JODI OAKLAND
Title or Position: OWNER/PHYSICAL THERAPIST
Credential:
Phone: 406-478-7769