1235332594 NPI number — LOLO PHYSICAL THERAPY PLLC

Table of content: DR. CRAIG A HAWKINS MD (NPI 1659394112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235332594 NPI number — LOLO PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOLO PHYSICAL THERAPY PLLC
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:
Provider Other Organization Name Type Code:
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:
1235332594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1627
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOLO
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59847-1627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-273-3730
Provider Business Mailing Address Fax Number:
406-273-9088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 TYLER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOLO
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59847-9714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-273-3730
Provider Business Practice Location Address Fax Number:
406-273-9088
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANDRY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
RAFE
Authorized Official Title or Position:
OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
406-273-3730

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1263PT , 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: 0000342363 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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