MEDICARE: CODI L BRISCOE DPT

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	225100000X	Physical Therapist	PTP-PT-LIC-21994	MT

General Provider Information

NPI Number	:	1861163966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODI L BRISCOE DPT

Provider Business Mailing Address
First Line	:	PO BOX 5718
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59903-5718
Country	:	US
Telephone Number	:	406-756-0134
Fax Number	:	406-300-1612

Provider Business Practice Location Address
First Line	:	1850 9TH ST W STE 2
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-4410
Country	:	US
Telephone Number	:	406-892-7999
Fax Number	:	406-892-0854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	12/01/2021

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Directions to “ CODI L BRISCOE DPT” Practice Location

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