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General NPI Number Information
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NPI Number | 1376678037
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Entity Type | Organization
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Legal Business Name | THREE FORKS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 203 S MAIN ST.
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City | THREE FORKS
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State | MT
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Zip | 59752
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Country | US
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Telephone | 406-285-0626
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Fax | 406-285-3500
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Provider Business Mailing Address
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Address Line | PO BOX 1180
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City | THREE FORKS
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State | MT
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Zip | 59752-1180
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Country | US
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Telephone | 406-285-0626
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Fax | 406-285-3500
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. NICOLE COLLEEN HECOCK
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Credential | P.T.
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Telephone | 406-285-0626
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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 | 1278
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License Number State | MT
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