Provider Demographics
NPI:1356522833
Name:MOUNTAIN VIEW PHYSICAL THERAPY AND SPORTS INJURY CLINIC, INC
Entity type:Organization
Organization Name:MOUNTAIN VIEW PHYSICAL THERAPY AND SPORTS INJURY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-454-0438
Mailing Address - Street 1:314 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2506
Mailing Address - Country:US
Mailing Address - Phone:406-454-0438
Mailing Address - Fax:406-727-8550
Practice Address - Street 1:314 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2506
Practice Address - Country:US
Practice Address - Phone:406-454-0438
Practice Address - Fax:406-727-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QR0400X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation