Provider Demographics
NPI:1093971566
Name:FORT MOHAVE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:FORT MOHAVE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-577-0336
Mailing Address - Street 1:1750 HIGHWAY 95
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6978
Mailing Address - Country:US
Mailing Address - Phone:928-577-0336
Mailing Address - Fax:928-577-0337
Practice Address - Street 1:5902 S HIGHWAY 95
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6078
Practice Address - Country:US
Practice Address - Phone:928-577-0336
Practice Address - Fax:928-577-0337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty