Provider Demographics
NPI:1245768183
Name:BITTERROOT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BITTERROOT PHYSICAL THERAPY LLC
Other - Org Name:WILLOW CREEK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER / REGISTERED AGENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-961-3841
Mailing Address - Street 1:PO BOX 630
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-0630
Mailing Address - Country:US
Mailing Address - Phone:406-961-3841
Mailing Address - Fax:
Practice Address - Street 1:1016 BROOKS AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828-9340
Practice Address - Country:US
Practice Address - Phone:406-961-3841
Practice Address - Fax:406-961-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy