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General NPI Number Information
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NPI Number | 1750600375
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Entity Type | Organization
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Legal Business Name | DEER LODGE VALLEY THERAPY
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 310 MAIN ST
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City | DEER LODGE
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State | MT
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Zip | 59722-1000
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Country | US
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Telephone | 406-846-3448
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Fax | 406-846-2298
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Provider Business Mailing Address
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Address Line | 310 MAIN ST
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City | DEER LODGE
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State | MT
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Zip | 59722-1000
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Country | US
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Telephone | 406-846-3448
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Fax | 406-846-2298
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Authorized Official
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Title or Position | OWER/PHYSICAL THERAPIST
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Name | MRS. RONDA WANGERIN
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Credential | P.T.
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Telephone | 406-846-3448
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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 | 100PT
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License Number State | MT
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