MEDICARE: MOUNTAIN VIEW PHYSICAL THERAPY AND SPORTS INJURY CLINIC, 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	261QR0400X	Rehabilitation Clinic/Center		MT
2	261QP2000X	Physical Therapy Clinic/Center		MT

General Provider Information

NPI Number	:	1356522833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VIEW PHYSICAL THERAPY AND SPORTS INJURY CLINIC, INC

Provider Business Mailing Address
First Line	:	314 1ST AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2506
Country	:	US
Telephone Number	:	406-454-0438
Fax Number	:	406-727-8550

Provider Business Practice Location Address
First Line	:	314 1ST AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2506
Country	:	US
Telephone Number	:	406-454-0438
Fax Number	:	406-727-8550

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MITCH D MOLEN
Credential	:
Telephone Number	:	406-454-0438

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	03/23/2023

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