Provider Demographics
NPI:1558063008
Name:MISSION MOBILE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:MISSION MOBILE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-273-8110
Mailing Address - Street 1:37053 BAPTISTE RD
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-8610
Mailing Address - Country:US
Mailing Address - Phone:406-273-8110
Mailing Address - Fax:
Practice Address - Street 1:37053 BAPTISTE RD
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-8610
Practice Address - Country:US
Practice Address - Phone:406-273-8110
Practice Address - Fax:406-303-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-20
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty