Provider Demographics
NPI:1003082165
Name:ANACONDA PHYSICAL THERAPY CENTER, PC
Entity Type:Organization
Organization Name:ANACONDA PHYSICAL THERAPY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORMAN-BADAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-563-2420
Mailing Address - Street 1:117 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-2240
Mailing Address - Country:US
Mailing Address - Phone:406-563-2420
Mailing Address - Fax:406-563-2420
Practice Address - Street 1:117 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2240
Practice Address - Country:US
Practice Address - Phone:406-563-2420
Practice Address - Fax:406-563-2420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty