1144477274 NPI number — NORTHWEST PHYSICAL THERAPY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144477274 NPI number — NORTHWEST PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THREE RIVERS PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144477274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORVALLIS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59828-1260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-541-8778
Provider Business Mailing Address Fax Number:
406-541-8780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2875 TINA AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59808-1582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-541-8778
Provider Business Practice Location Address Fax Number:
406-541-8780
Provider Enumeration Date:
08/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUMPHREY
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
ERNEST
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-541-8778

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1669 , 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)





Copyright © 2007-2024 www.npivalidator.com