1144433137 NPI number — ALISA DAWN COX D.P.T.

Table of content: LYNNE MARIE SMITH MS (NPI 1477865855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144433137 NPI number — ALISA DAWN COX D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COX
Provider First Name:
ALISA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERGROOS
Provider Other First Name:
ALISA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144433137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KRMC OUTPATIENT THERAPY SERVICES AT THE SUMMIT
Provider Second Line Business Mailing Address:
205 SUNNYVIEW LANE
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-751-4520
Provider Business Mailing Address Fax Number:
406-751-4526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KRMC OUTPATIENT THERAPY SERVICES AT THE SUMMIT
Provider Second Line Business Practice Location Address:
205 SUNNYVIEW LANE
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-751-4520
Provider Business Practice Location Address Fax Number:
406-751-4526
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1428PT , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)