Provider Demographics
NPI:1376934729
Name:WILDHORSE
Entity Type:Organization
Organization Name:WILDHORSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/HEAD INSTRUCTOR/PATH REGIS
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:PATH INTL REGISTERE
Authorized Official - Phone:406-203-2412
Mailing Address - Street 1:1511 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2129
Mailing Address - Country:US
Mailing Address - Phone:406-203-2412
Mailing Address - Fax:
Practice Address - Street 1:3700 E CARLTON CREEK RD
Practice Address - Street 2:NATURAL HORSEMAN LLC
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6160
Practice Address - Country:US
Practice Address - Phone:406-273-4818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTCAT8188 NPI USER IOtherPATH INTERNATIONAL #54436 REGISTERED THERAPEUTIC RIDING INSTRUCTOR