Healthcare Provider Details

I. General information

NPI: 1679567770
Provider Name (Legal Business Name): WHITEFISH PHYSICAL THERAPY & SPORTS REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOSPITAL WAY
WHITEFISH MT
59937-7858
US

IV. Provider business mailing address

PO BOX 4357
WHITEFISH MT
59937-4357
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-9378
  • Fax: 406-862-9882
Mailing address:
  • Phone: 406-862-9378
  • Fax: 406-862-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1367PT
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY E SEEFELDT
Title or Position: STAFF END USER
Credential:
Phone: 406-862-9378