Provider Demographics
NPI:1871251173
Name:BKL REHAB LLC
Entity Type:Organization
Organization Name:BKL REHAB LLC
Other - Org Name:ADVOCATE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:253-682-9645
Mailing Address - Street 1:3051 CABERNET DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8644
Mailing Address - Country:US
Mailing Address - Phone:406-282-1030
Mailing Address - Fax:406-422-0626
Practice Address - Street 1:3051 CABERNET DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8644
Practice Address - Country:US
Practice Address - Phone:406-282-1030
Practice Address - Fax:406-422-0626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1871070599Medicaid