Provider Demographics
NPI:1811700305
Name:LONE PEAK PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:LONE PEAK PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BO
Authorized Official - Middle Name:
Authorized Official - Last Name:SELVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-589-4588
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:812-759-7451
Mailing Address - Fax:812-590-8333
Practice Address - Street 1:1741 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2937
Practice Address - Country:US
Practice Address - Phone:406-969-6610
Practice Address - Fax:406-969-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies