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General NPI Number Information
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NPI Number | 1275198996
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Entity Type | Organization
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Legal Business Name | PEDS TELETHERAPY
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 6062 LOWER MILLER CREEK RD
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City | MISSOULA
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State | MT
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Zip | 59803-9625
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Country | US
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Telephone | 406-813-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 6062 LOWER MILLER CREEK RD
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City | MISSOULA
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State | MT
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Zip | 59803-9625
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Country | US
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Telephone | 406-813-1150
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | ALICE LAVERDIERE
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Credential | PT
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Telephone | 406-813-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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