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NPI Code Detail

MEDICARE: FUNCTIONAL PERFORMANCE THERAPY, INC.

MEDICARE: FUNCTIONAL PERFORMANCE THERAPY, 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
1225XP0200XPediatric Occupational Therapist

General Provider Information

NPI Number : 1811141914
Entity Type Code : Organization
Provider Name (Legal Business Name) : FUNCTIONAL PERFORMANCE THERAPY, INC.
Provider Business Mailing Address
First Line : PO BOX 171
Second Line :
City : FLORENCE
State : MT
Zip : 59833-0171
Country : US
Telephone Number : 406-214-2606
Fax Number : 406-551-7300
Provider Business Practice Location Address
First Line : 901 SW HIGGINS AVE
Second Line :
City : MISSOULA
State : MT
Zip : 59803-3600
Country : US
Telephone Number : 406-214-2606
Fax Number : 406-551-7300
Authorized Official
Title or Position : OT/OWNER
Name : EDWARD A BONIECKI
Credential : OT/L
Telephone Number : 406-214-2606
Provider Enumeration Date : 11/17/2008
Last Update Date : 02/20/2025

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