1437331063 NPI number — TIM CORDIAL PT PC

Table of content: (NPI 1437331063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437331063 NPI number — TIM CORDIAL PT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIM CORDIAL PT PC
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:
CORDIAL 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:
1437331063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 W SPRUCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802-3904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-721-8858
Provider Business Mailing Address Fax Number:
406-542-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W SPRUCE ST
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:
59802-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-721-8858
Provider Business Practice Location Address Fax Number:
406-542-0960
Provider Enumeration Date:
12/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORDIAL
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
406-721-8858

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  257 , 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)

  • Identifier: 0000344097 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com