Provider Demographics
NPI:1720375595
Name:ADVANCED PRACTICE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ADVANCED PRACTICE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:406-781-2247
Mailing Address - Street 1:900 2ND ST. S. SUITE 2
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4014
Mailing Address - Country:US
Mailing Address - Phone:406-770-3171
Mailing Address - Fax:406-770-3173
Practice Address - Street 1:900 2ND ST. S. SUITE 2
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4014
Practice Address - Country:US
Practice Address - Phone:406-781-2247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty