Provider Demographics
NPI:1689339236
Name:PALAGI, BERT
Entity Type:Individual
Prefix:
First Name:BERT
Middle Name:
Last Name:PALAGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 POWERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7716
Mailing Address - Country:US
Mailing Address - Phone:406-781-5090
Mailing Address - Fax:
Practice Address - Street 1:403 GALLATIN FARMERS AVE
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9142
Practice Address - Country:US
Practice Address - Phone:406-388-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-19449225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant