Provider Demographics
NPI:1811141914
Name:FUNCTIONAL PERFORMANCE THERAPY, INC.
Entity type:Organization
Organization Name:FUNCTIONAL PERFORMANCE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BONIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:406-214-2606
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-0171
Mailing Address - Country:US
Mailing Address - Phone:406-214-2606
Mailing Address - Fax:406-551-7300
Practice Address - Street 1:901 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-3600
Practice Address - Country:US
Practice Address - Phone:406-214-2606
Practice Address - Fax:406-551-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty