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General NPI Number Information
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NPI Number | 1457978983
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Entity Type | Organization
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Legal Business Name | GLACIER PEAKS MOBILE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 535 4TH AVE W
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City | COLUMBIA FALLS
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State | MT
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Zip | 59912-3605
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Country | US
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Telephone | 406-426-1560
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Fax | 406-510-2933
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Provider Business Mailing Address
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Address Line | PO BOX 5086
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City | WHITEFISH
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State | MT
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Zip | 59937-5086
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Country | US
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Telephone | 406-426-1560
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Fax | 406-510-2933
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | JACQUELYN R BULLOCK
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Credential | DPT
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Telephone | 406-426-1560
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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 |
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Taxonomy #2
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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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