Provider Demographics
NPI:1295047371
Name:LOLO PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:LOLO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-273-3730
Mailing Address - Street 1:106 TYLER WAY
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-9714
Mailing Address - Country:US
Mailing Address - Phone:406-273-3730
Mailing Address - Fax:406-273-9088
Practice Address - Street 1:106 TYLER WAY
Practice Address - Street 2:
Practice Address - City:LOLO
Practice Address - State:MT
Practice Address - Zip Code:59847-9714
Practice Address - Country:US
Practice Address - Phone:406-273-3730
Practice Address - Fax:406-273-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1263MT261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy