Provider Demographics
NPI:1780854927
Name:DEER LODGE VALLEY THERAPY CLINIC, INC.
Entity Type:Organization
Organization Name:DEER LODGE VALLEY THERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCCATHY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-846-3448
Mailing Address - Street 1:310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1057
Mailing Address - Country:US
Mailing Address - Phone:406-846-3448
Mailing Address - Fax:408-846-2298
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1057
Practice Address - Country:US
Practice Address - Phone:406-846-3448
Practice Address - Fax:408-846-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT131261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1255493516Medicaid
MT1487716734Medicaid
000050775Medicare PIN
MT000050602Medicare PIN
MT1255493516Medicaid