Provider Demographics
NPI:1912201005
Name:LONE PEAK PHYSICAL THERAPY AT BELGRADE
Entity Type:Organization
Organization Name:LONE PEAK PHYSICAL THERAPY AT BELGRADE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:406-388-7229
Mailing Address - Street 1:403 GALLATIN FARMERS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-9142
Mailing Address - Country:US
Mailing Address - Phone:406-388-7229
Mailing Address - Fax:406-388-7229
Practice Address - Street 1:403 GALLATIN FARMERS AVE
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-9142
Practice Address - Country:US
Practice Address - Phone:406-388-7229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty