Provider Demographics
NPI:1669535928
Name:VOGELZANG PHYSICAL THERAPY
Entity type:Organization
Organization Name:VOGELZANG PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOGELZANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-544-5679
Mailing Address - Street 1:1900 W BROADWAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1825
Mailing Address - Country:US
Mailing Address - Phone:406-544-5679
Mailing Address - Fax:
Practice Address - Street 1:1900 W BROADWAY ST STE C
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1825
Practice Address - Country:US
Practice Address - Phone:406-544-5679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1576PT2251X0800X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0052326Medicaid
MT0000050832Medicare PIN