Provider Demographics
NPI:1437331063
Name:TIM CORDIAL PT PC
Entity Type:Organization
Organization Name:TIM CORDIAL PT PC
Other - Org Name:CORDIAL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORDIAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-721-8858
Mailing Address - Street 1:701 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3904
Mailing Address - Country:US
Mailing Address - Phone:406-721-8858
Mailing Address - Fax:406-542-0960
Practice Address - Street 1:701 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3904
Practice Address - Country:US
Practice Address - Phone:406-721-8858
Practice Address - Fax:406-542-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT257261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000344097Medicaid