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General NPI Number Information
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NPI Number | 1407362049
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Entity Type | Organization
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Legal Business Name | PARKSIDE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/19/2017
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Last Update Date | 12/19/2017
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Provider Practice Location Address
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Address Line | 235 FIREHOLE AVE
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City | WEST YELLOWSTONE
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State | MT
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Zip | 59758-1573
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Country | US
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Telephone | 406-646-7068
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Fax | 406-646-7069
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Provider Business Mailing Address
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Address Line | PO BOX 1573
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City | WEST YELLOWSTONE
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State | MT
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Zip | 59758-1573
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Country | US
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Telephone | 406-646-7068
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Fax | 406-646-7069
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | JENNIFER L JORDAN
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Credential | P.T
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Telephone | 406-646-7068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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