MEDICARE: BIGFORK PHYSICAL THERAPY & SPORTS REHABILITATION 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	261QP2000X	Physical Therapy Clinic/Center	1350PT	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	61996	OTHER	MT	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1649277799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIGFORK PHYSICAL THERAPY & SPORTS REHABILITATION INC

Provider Business Mailing Address
First Line	:	PO BOX 1527
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911-1527
Country	:	US
Telephone Number	:	406-837-6892
Fax Number	:	406-837-6435

Provider Business Practice Location Address
First Line	:	6400 MT HWY 35
Second Line	:
City	:	BIGFORK
State	:	MT
Zip	:	59911
Country	:	US
Telephone Number	:	406-837-6892
Fax Number	:	406-837-6435

Authorized Official
Title or Position	:	OWNER PHYSICAL THERAPIST
Name	:	MICHAEL JON CLOSE
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	406-837-6892

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	10/30/2007

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Directions to “BIGFORK PHYSICAL THERAPY & SPORTS REHABILITATION INC ” Practice Location

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