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NPI Code Detail

MEDICARE: BITTERROOT PHYSICAL THERAPY LLC

MEDICARE: BITTERROOT PHYSICAL THERAPY LLC
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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1245768183
Entity Type Code : Organization
Provider Name (Legal Business Name) : BITTERROOT PHYSICAL THERAPY LLC
Provider Business Mailing Address
First Line : PO BOX 630
Second Line :
City : CORVALLIS
State : MT
Zip : 59828-0630
Country : US
Telephone Number : 406-961-3841
Fax Number :
Provider Business Practice Location Address
First Line : 1016 BROOKS AVE
Second Line :
City : CORVALLIS
State : MT
Zip : 59828-9340
Country : US
Telephone Number : 406-961-3841
Fax Number : 406-961-6814
Authorized Official
Title or Position : MEMBER / REGISTERED AGENT / OWNER
Name : DREW HULS
Credential :
Telephone Number : 406-961-3841
Provider Enumeration Date : 05/23/2017
Last Update Date : 05/19/2022

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Directions to “BITTERROOT PHYSICAL THERAPY LLC ” Practice Location

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