Provider Demographics
NPI:1629171517
Name:ENNIS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ENNIS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SAHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-682-3112
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-0921
Mailing Address - Country:US
Mailing Address - Phone:406-682-3112
Mailing Address - Fax:
Practice Address - Street 1:110 SOUTH FIRST STREET
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-0921
Practice Address - Country:US
Practice Address - Phone:406-682-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT683225100000X, 2251G0304X, 2251N0400X, 2251S0007X, 2251X0800X
6832251X0800X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0345950Medicaid
MT061286OtherBLUE CROSS BLUE SHIELD
MT0345950Medicaid
MTP18527Medicare UPIN
MT50574Medicare ID - Type UnspecifiedPROVIDER NUMBER