Provider Demographics
NPI:1649336413
Name:MONTANA PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:MONTANA PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-248-8804
Mailing Address - Street 1:2370 AVENUE C
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7102
Mailing Address - Country:US
Mailing Address - Phone:406-248-8804
Mailing Address - Fax:406-248-8829
Practice Address - Street 1:2370 AVENUE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7102
Practice Address - Country:US
Practice Address - Phone:406-248-8804
Practice Address - Fax:406-248-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTCK4100Medicare PIN
MT000082837Medicare PIN