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General NPI Number Information
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NPI Number | 1255015921
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Entity Type | Organization
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Legal Business Name | BERUBE PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 06/13/2023
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 906 9TH ST W
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-3874
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Country | US
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Telephone | 406-206-4180
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 CORTE DEL NOGAL STE 200
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City | CARLSBAD
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State | CA
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Zip | 92011-1445
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Country | US
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Telephone | 760-931-8310
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | NICHOLAS POAN
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Credential |
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Telephone | 760-931-8310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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