Provider Demographics
NPI:1710372123
Name:IMPACT SPORTS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:IMPACT SPORTS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC, MTC
Authorized Official - Phone:303-902-5456
Mailing Address - Street 1:432 E IDAHO ST
Mailing Address - Street 2:STE. 431
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4137
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:432 E IDAHO ST
Practice Address - Street 2:STE. 431
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4137
Practice Address - Country:US
Practice Address - Phone:303-902-5456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty