MEDICARE: GLACIER PEAKS MOBILE 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
1	261QP2000X	Physical Therapy Clinic/Center
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1457978983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLACIER PEAKS MOBILE PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 5086
Second Line	:
City	:	WHITEFISH
State	:	MT
Zip	:	59937-5086
Country	:	US
Telephone Number	:	406-426-1560
Fax Number	:	406-510-2933

Provider Business Practice Location Address
First Line	:	535 4TH AVE W
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-3605
Country	:	US
Telephone Number	:	406-426-1560
Fax Number	:	406-510-2933

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	JACQUELYN R BULLOCK
Credential	:	DPT
Telephone Number	:	406-426-1560

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	01/12/2026

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