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General NPI Number Information
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NPI Number | 1811141914
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL PERFORMANCE THERAPY, INC.
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 901 SW HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59803-3600
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Country | US
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Telephone | 406-214-2606
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Fax | 406-551-7300
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Provider Business Mailing Address
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Address Line | PO BOX 171
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City | FLORENCE
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State | MT
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Zip | 59833-0171
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Country | US
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Telephone | 406-214-2606
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Fax | 406-551-7300
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Authorized Official
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Title or Position | OT/OWNER
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Name | EDWARD A BONIECKI
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Credential | OT/L
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Telephone | 406-214-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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