Provider Demographics
NPI:1376013557
Name:PHYSIOTREKK
Entity Type:Organization
Organization Name:PHYSIOTREKK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:VERSTEEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-207-6440
Mailing Address - Street 1:150 E SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4504
Mailing Address - Country:US
Mailing Address - Phone:406-207-3787
Mailing Address - Fax:
Practice Address - Street 1:150 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4504
Practice Address - Country:US
Practice Address - Phone:406-207-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty