Provider Demographics
NPI:1992595797
Name:LIVE WELL VT LLC
Entity type:Organization
Organization Name:LIVE WELL VT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-201-9020
Mailing Address - Street 1:PO BOX 10491
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59719-0491
Mailing Address - Country:US
Mailing Address - Phone:406-201-9020
Mailing Address - Fax:
Practice Address - Street 1:609 PRONGHORN TRL # C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7090
Practice Address - Country:US
Practice Address - Phone:406-201-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy