Provider Demographics
NPI:1114596764
Name:MONTANA LEGACY PT, PLLC
Entity Type:Organization
Organization Name:MONTANA LEGACY PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:ROSENCRANZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-852-7335
Mailing Address - Street 1:618 S LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-4529
Mailing Address - Country:US
Mailing Address - Phone:406-852-7335
Mailing Address - Fax:
Practice Address - Street 1:1009 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3409
Practice Address - Country:US
Practice Address - Phone:406-852-7335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy