Healthcare Provider Details

I. General information

NPI: 1558536227
Provider Name (Legal Business Name): FLATHEAD PERFORMANCE TRAINING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HOSPITAL WAY
WHITEFISH MT
59937-7858
US

IV. Provider business mailing address

2006 HOSPITAL WAY
WHITEFISH MT
59937-7858
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-8250
  • Fax: 406-862-9882
Mailing address:
  • Phone: 406-862-8250
  • Fax: 406-862-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DENNIS CAREY
Title or Position: OWNER
Credential: LAT, ATC
Phone: 406-862-8250