Provider Demographics
NPI:1932850021
Name:RANGE PHYSICAL THERAPY & WELLNESS PLLC
Entity Type:Organization
Organization Name:RANGE PHYSICAL THERAPY & WELLNESS PLLC
Other - Org Name:RANGE PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:406-214-4098
Mailing Address - Street 1:226 DEARBORN AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8118
Mailing Address - Country:US
Mailing Address - Phone:406-214-4098
Mailing Address - Fax:
Practice Address - Street 1:945 WYOMING ST UNIT 135
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2057
Practice Address - Country:US
Practice Address - Phone:406-370-1377
Practice Address - Fax:408-258-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty