Provider Demographics
NPI:1932283926
Name:GAIL NEVIN PHYSICAL THERAPY P C
Entity Type:Organization
Organization Name:GAIL NEVIN PHYSICAL THERAPY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PC PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-542-0177
Mailing Address - Street 1:309 SW HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1405
Mailing Address - Country:US
Mailing Address - Phone:406-542-0177
Mailing Address - Fax:406-721-1978
Practice Address - Street 1:309 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1405
Practice Address - Country:US
Practice Address - Phone:406-542-0177
Practice Address - Fax:406-721-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPT213261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0348725Medicaid
000005037Medicare ID - Type Unspecified