MEDICARE: ALPINE PRIME PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	10407	MT

General Provider Information

NPI Number	:	1043756109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE PRIME PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	330 11TH AVE
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-3740
Country	:	US
Telephone Number	:	406-441-4445
Fax Number	:	406-441-4447

Provider Business Practice Location Address
First Line	:	330 11TH AVE
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-3740
Country	:	US
Telephone Number	:	406-441-4445
Fax Number	:	406-441-4447

Authorized Official
Title or Position	:	OWNER
Name	:	KARI KOCKLER
Credential	:	PT
Telephone Number	:	406-441-4445

Provider Enumeration Date	:	01/13/2017
Last Update Date	:	01/13/2017

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