Provider Demographics
NPI:1659600203
Name:CLEARWATER THERAPEUTICS LLC
Entity Type:Organization
Organization Name:CLEARWATER THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JORDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-585-3701
Mailing Address - Street 1:117 E OAK ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2977
Mailing Address - Country:US
Mailing Address - Phone:406-585-3701
Mailing Address - Fax:406-586-9708
Practice Address - Street 1:117 E OAK ST STE 1A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2977
Practice Address - Country:US
Practice Address - Phone:406-585-3701
Practice Address - Fax:406-586-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT18612251X0800X
MTMT23602251X0800X
MTMT22892251X0800X
MT1861261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty