Provider Demographics
NPI:1376222836
Name:PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND WELLNESS
Other - Org Name:ROOTED PELVIC HEALTH AND YOGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THEARPIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSETER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:406-219-1090
Mailing Address - Street 1:410 N 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2506
Mailing Address - Country:US
Mailing Address - Phone:406-219-1090
Mailing Address - Fax:
Practice Address - Street 1:410 N 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2506
Practice Address - Country:US
Practice Address - Phone:406-219-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty