Provider Demographics
NPI:1588022594
Name:UNIVERSITY OF MONTANA
Entity Type:Organization
Organization Name:UNIVERSITY OF MONTANA
Other - Org Name:NEURAL INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMBIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAPATRA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:406-243-2429
Mailing Address - Street 1:32 CAMPUS DR
Mailing Address - Street 2:SKAGGS BLDG., STE 135
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-0004
Mailing Address - Country:US
Mailing Address - Phone:406-243-5189
Mailing Address - Fax:
Practice Address - Street 1:32 CAMPUS DR
Practice Address - Street 2:SKAGGS BLDG., STE 115
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-4494
Practice Address - Country:US
Practice Address - Phone:406-243-4017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MONTANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-04
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X, 225100000X, 261Q00000X, 261QR0400X, 293D00000X
MTPTP-PT-LIC-5072081P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty