Provider Demographics
NPI:1558536227
Name:FLATHEAD PERFORMANCE TRAINING CENTER, LLC
Entity Type:Organization
Organization Name:FLATHEAD PERFORMANCE TRAINING CENTER, LLC
Other - Org Name:FLATHEAD PERFORMANCE TRAINING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:CAREY
Authorized Official - Suffix:
Authorized Official - Credentials:LAT, ATC
Authorized Official - Phone:406-862-8250
Mailing Address - Street 1:2006 HOSPITAL WAY
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7858
Mailing Address - Country:US
Mailing Address - Phone:406-862-8250
Mailing Address - Fax:406-862-9882
Practice Address - Street 1:2006 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7858
Practice Address - Country:US
Practice Address - Phone:406-862-8250
Practice Address - Fax:406-862-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1558536227Medicaid
MT6216800001Medicare NSC