Provider Demographics
NPI:1982913810
Name:PHYSICAL THERAPY SPECIALISTS OF FLORENCE P.C.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS OF FLORENCE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:406-375-0980
Mailing Address - Street 1:293 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6859
Mailing Address - Country:US
Mailing Address - Phone:406-273-9033
Mailing Address - Fax:406-273-0993
Practice Address - Street 1:293 RODEO DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6859
Practice Address - Country:US
Practice Address - Phone:406-273-9033
Practice Address - Fax:406-273-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1982913810Medicaid
MTM011000673OtherMEDICARE B PIN
MT1982913810Medicare PIN