Provider Demographics
NPI:1891168001
Name:PRIME THERAPIES INC.
Entity Type:Organization
Organization Name:PRIME THERAPIES INC.
Other - Org Name:PRIME PERFORMANCE AND PHYSIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLENAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-599-9518
Mailing Address - Street 1:58 SILVER LEAF LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9625
Mailing Address - Country:US
Mailing Address - Phone:406-599-9518
Mailing Address - Fax:406-545-3394
Practice Address - Street 1:58 SILVER LEAF LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9625
Practice Address - Country:US
Practice Address - Phone:406-599-9518
Practice Address - Fax:406-545-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-9412225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty