=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700560745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN HOME PT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2023
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1643 LEWIS AVE STE 7
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-545-2535
-----------------------------------------------------
Fax | 406-412-0537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1925 GRAND AVE STE 129 PMB 147699
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-545-2535
-----------------------------------------------------
Fax | 406-412-0537
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MICHELLE CARLILE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-545-2535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------