Healthcare Provider Details

I. General information

NPI: 1376678037
Provider Name (Legal Business Name): THREE FORKS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAIN ST.
THREE FORKS MT
59752
US

IV. Provider business mailing address

PO BOX 1180
THREE FORKS MT
59752-1180
US

V. Phone/Fax

Practice location:
  • Phone: 406-285-0626
  • Fax: 406-285-3500
Mailing address:
  • Phone: 406-285-0626
  • Fax: 406-285-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1278
License Number StateMT

VIII. Authorized Official

Name: MRS. NICOLE COLLEEN HECOCK
Title or Position: PRESIDENT
Credential: P.T.
Phone: 406-285-0626