MEDICARE: ORTHO PT 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	1589	MT

General Provider Information

NPI Number	:	1477782258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO PT LLC

Provider Business Mailing Address
First Line	:	3031 S RUSSELL ST
Second Line	:	SUITE 5
City	:	MISSOULA
State	:	MT
Zip	:	59801-8523
Country	:	US
Telephone Number	:	406-531-0043
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 S RUSSELL ST
Second Line	:	SUITE 5
City	:	MISSOULA
State	:	MT
Zip	:	59801-8523
Country	:	US
Telephone Number	:	406-531-0043
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	RICH DANIELSON
Credential	:	P.T.
Telephone Number	:	406-531-0043

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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Directions to “ORTHO PT LLC ” Practice Location

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