Provider Demographics
NPI:1508278581
Name:ORTHOPEDIC REHAB INC
Entity Type:Organization
Organization Name:ORTHOPEDIC REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GULICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-407-7990
Mailing Address - Street 1:25 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3100
Mailing Address - Country:US
Mailing Address - Phone:406-407-7990
Mailing Address - Fax:
Practice Address - Street 1:201 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3537
Practice Address - Country:US
Practice Address - Phone:406-683-3675
Practice Address - Fax:406-683-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty