Provider Demographics
NPI:1316218795
Name:GOLD LEAF PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:GOLD LEAF PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESLAHPAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-442-4325
Mailing Address - Street 1:PO BOX 1902
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-1902
Mailing Address - Country:US
Mailing Address - Phone:406-442-4325
Mailing Address - Fax:800-934-8039
Practice Address - Street 1:701 HELENA AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3645
Practice Address - Country:US
Practice Address - Phone:406-442-4325
Practice Address - Fax:800-934-8039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty