Provider Demographics
NPI:1700325420
Name:BERUBE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:BERUBE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DULCINEA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:406-987-2404
Mailing Address - Street 1:PO BOX 2828
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-2828
Mailing Address - Country:US
Mailing Address - Phone:406-897-2404
Mailing Address - Fax:406-897-2357
Practice Address - Street 1:906 9TH ST W UNIT A (NEW)
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-3806
Practice Address - Country:US
Practice Address - Phone:406-897-2404
Practice Address - Fax:406-897-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty