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General NPI Number Information
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NPI Number | 1841217742
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Entity Type | Organization
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Legal Business Name | OCONNELL PT, INC
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3627 S 7TH ST W
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City | MISSOULA
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State | MT
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Zip | 59804-1919
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Country | US
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Telephone | 406-546-4767
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Fax | 406-543-5723
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Provider Business Mailing Address
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Address Line | 3627 S 7TH ST W
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City | MISSOULA
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State | MT
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Zip | 59804-1919
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Country | US
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Telephone | 406-546-4767
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Fax | 406-543-5723
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Authorized Official
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Title or Position | OWNER
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Name | MARY O'CONNELL
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Credential | PT
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Telephone | 406-546-4767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | MT458
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License Number State | MT
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