Provider Demographics
NPI:1225562416
Name:PHYSICAL THERAPY ELITE, LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY ELITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY, PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-404-1313
Mailing Address - Street 1:3701 TRAKKER TRL
Mailing Address - Street 2:2E
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8877
Mailing Address - Country:US
Mailing Address - Phone:406-404-1313
Mailing Address - Fax:
Practice Address - Street 1:3701 TRAKKER TRL
Practice Address - Street 2:2E
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8877
Practice Address - Country:US
Practice Address - Phone:406-404-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty