Provider Demographics
NPI:1982144093
Name:BATTLE MOUNTAIN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:BATTLE MOUNTAIN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-426-9647
Mailing Address - Street 1:244 S CHICAGO ST
Mailing Address - Street 2:OR P.O. BOX 732
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747
Mailing Address - Country:US
Mailing Address - Phone:605-745-4761
Mailing Address - Fax:605-745-4762
Practice Address - Street 1:244 S CHICAGO ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747
Practice Address - Country:US
Practice Address - Phone:605-745-4761
Practice Address - Fax:605-745-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1492225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1699740605Medicaid