Provider Demographics
NPI:1932258001
Name:FLORENCE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:FLORENCE PHYSICAL THERAPY INC
Other - Org Name:WILLOW CREEK PHYSICAL THERAPY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-273-4246
Mailing Address - Street 1:PO BOX 1260
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-1260
Mailing Address - Country:US
Mailing Address - Phone:406-273-4246
Mailing Address - Fax:406-273-4341
Practice Address - Street 1:5529 OLD US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6564
Practice Address - Country:US
Practice Address - Phone:406-273-4246
Practice Address - Fax:406-273-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT360649900OtherOWCP WORKERS COMPENSATION
MTDA2139Medicare PIN
MT000082904Medicare UPIN