Provider Demographics
NPI:1073250668
Name:VALKRYIE FITNESS AND REHAB LLC
Entity Type:Organization
Organization Name:VALKRYIE FITNESS AND REHAB LLC
Other - Org Name:LITTLE LEGENDS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TENIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAPOUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:406-647-0042
Mailing Address - Street 1:PO BOX 21152
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-1152
Mailing Address - Country:US
Mailing Address - Phone:406-647-0042
Mailing Address - Fax:406-204-7933
Practice Address - Street 1:1601 LEWIS AVE STE 107
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4182
Practice Address - Country:US
Practice Address - Phone:406-647-0042
Practice Address - Fax:406-204-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty