MEDICARE: GRANT DAMON POOR M.S., P.T.

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	1258 PT	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60396	OTHER	MT	BC/BS OF MT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194740928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT DAMON POOR M.S., P.T.

Provider Business Mailing Address
First Line	:	PO BOX 457
Second Line	:
City	:	FAIRFIELD
State	:	MT
Zip	:	59436
Country	:	US
Telephone Number	:	406-467-3800
Fax Number	:	406-467-3828

Provider Business Practice Location Address
First Line	:	15 6TH ST S
Second Line	:
City	:	FAIRFIELD
State	:	MT
Zip	:	59436
Country	:	US
Telephone Number	:	406-467-3800
Fax Number	:	406-467-3828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	11/14/2025

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