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General NPI Number Information
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NPI Number | 1053798736
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Entity Type | Organization
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Legal Business Name | ENDURANCE PHYSIO
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 214 E. MAIN ST
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City | MISSOULA
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State | MT
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Zip | 59802
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Country | US
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Telephone | 406-531-3019
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Fax |
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Provider Business Mailing Address
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Address Line | 214 E MAIN ST
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City | MISSOULA
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State | MT
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Zip | 59802-4418
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Country | US
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Telephone | 406-926-2150
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Fax | 406-258-0724
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JAMIE TERRY
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Credential | P.T.
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Telephone | 406-531-3019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PTP-PT-LIC-2353
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License Number State | MT
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