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General NPI Number Information
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NPI Number | 1669535928
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Entity Type | Organization
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Legal Business Name | VOGELZANG PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 1900 W BROADWAY ST STE C
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City | MISSOULA
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State | MT
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Zip | 59808-1825
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Country | US
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Telephone | 406-544-5679
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 W BROADWAY ST STE C
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City | MISSOULA
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State | MT
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Zip | 59808-1825
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Country | US
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Telephone | 406-544-5679
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN VOGELZANG
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Credential | PT
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Telephone | 406-544-5679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1576PT
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 1576PT
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License Number State | MT
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