MEDICARE: PHYSICAL THERAPY ON THE MOVE PC

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	571PT	MT

General Provider Information

NPI Number	:	1063622264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY ON THE MOVE PC

Provider Business Mailing Address
First Line	:	1219 TULIP LN
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-3048
Country	:	US
Telephone Number	:	406-240-2172
Fax Number	:	406-241-0767

Provider Business Practice Location Address
First Line	:	1219 TULIP LN
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-3048
Country	:	US
Telephone Number	:	406-240-2172
Fax Number	:	406-241-0767

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LARRY R. PLANT
Credential	:	PT
Telephone Number	:	406-240-2172

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	01/07/2008

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Directions to “PHYSICAL THERAPY ON THE MOVE PC ” Practice Location

Language	Start Address	Practice Location

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