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General NPI Number Information
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NPI Number | 1336575711
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Entity Type | Organization
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Legal Business Name | GREAT DIVIDE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 2819 GREAT NORTHERN LOOP STE 300
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City | MISSOULA
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State | MT
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Zip | 59808-1750
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Country | US
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Telephone | 406-317-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 2819 GREAT NORTHERN LOOP STE 300
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City | MISSOULA
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State | MT
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Zip | 59808-1750
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Country | US
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Telephone | 406-317-1121
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Fax | 406-317-1875
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | KATE M SKINNER
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Credential | DPT
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Telephone | 406-317-1121
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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 |
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License Number State | MT
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