Provider Demographics
NPI:1568079523
Name:TRAILHEAD HEALTH & REHAB LLC
Entity Type:Organization
Organization Name:TRAILHEAD HEALTH & REHAB LLC
Other - Org Name:TRAILHEAD PHYSICAL THERAPY & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIMAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-756-1128
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-300-1612
Practice Address - Street 1:1838 W PARKSIDE LN STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1370
Practice Address - Country:US
Practice Address - Phone:970-712-2938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty