Provider Demographics
NPI:1578585592
Name:UNIVERSITY OF MONTANA
Entity Type:Organization
Organization Name:UNIVERSITY OF MONTANA
Other - Org Name:UNIVERSITY OF MONTANA PHYSICAL THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-243-4006
Mailing Address - Street 1:32 CAMPUS DR
Mailing Address - Street 2:SKAGGS BLDG #129
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-4680
Mailing Address - Country:US
Mailing Address - Phone:406-243-4006
Mailing Address - Fax:406-243-2795
Practice Address - Street 1:32 CAMPUS DR
Practice Address - Street 2:SKAGGS BLDG #129
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-4680
Practice Address - Country:US
Practice Address - Phone:406-243-4006
Practice Address - Fax:406-243-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083667Medicare ID - Type Unspecified