Provider Demographics
NPI:1679567770
Name:WHITEFISH PHYSICAL THERAPY & SPORTS REHAB, INC.
Entity Type:Organization
Organization Name:WHITEFISH PHYSICAL THERAPY & SPORTS REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF END USER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEEFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-862-9378
Mailing Address - Street 1:PO BOX 4357
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-4357
Mailing Address - Country:US
Mailing Address - Phone:406-862-9378
Mailing Address - Fax:406-862-9882
Practice Address - Street 1:2006 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7858
Practice Address - Country:US
Practice Address - Phone:406-862-9378
Practice Address - Fax:406-862-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1367PT225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0345338Medicaid
MT0345338Medicaid