Provider Demographics
NPI:1013957406
Name:SAPPHIRE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:SAPPHIRE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-549-5283
Mailing Address - Street 1:1705 BOW ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5652
Mailing Address - Country:US
Mailing Address - Phone:406-549-5283
Mailing Address - Fax:406-549-5392
Practice Address - Street 1:1705 BOW ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5652
Practice Address - Country:US
Practice Address - Phone:406-549-5283
Practice Address - Fax:406-549-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT809174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT=========OtherEIN