MEDICARE: MOUNTAIN PHYSICAL THERAPY, 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

General Provider Information

NPI Number	:	1154744878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	2593 US HIGHWAY 2 E
Second Line	:	SUITE 6
City	:	KALISPELL
State	:	MT
Zip	:	59901-9507
Country	:	US
Telephone Number	:	406-257-0933
Fax Number	:	406-257-3426

Provider Business Practice Location Address
First Line	:	2593 US HIGHWAY 2 E
Second Line	:	SUITE 6
City	:	KALISPELL
State	:	MT
Zip	:	59901-9507
Country	:	US
Telephone Number	:	406-257-0933
Fax Number	:	406-257-3426

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	MRS. JOANNE S ROBINSON
Credential	:
Telephone Number	:	406-257-0933

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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