Provider Demographics
NPI:1649320011
Name:GLACIER PILATES AND PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:GLACIER PILATES AND PHYSICAL THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SATHER-HEYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:406-261-5840
Mailing Address - Street 1:PO BOX 4985
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-4985
Mailing Address - Country:US
Mailing Address - Phone:406-261-5840
Mailing Address - Fax:406-862-2112
Practice Address - Street 1:576 SPOKANE AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2781
Practice Address - Country:US
Practice Address - Phone:406-261-5840
Practice Address - Fax:406-862-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60713OtherBC & BS
MT3401292Medicaid