1588110977 NPI number — ASPIRE FITNESS PHYSICAL THERAPY

Table of content: (NPI 1588110977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588110977 NPI number — ASPIRE FITNESS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRE FITNESS PHYSICAL THERAPY
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:
FITNESS 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:
1588110977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
945 WYOMING STREET
Provider Second Line Business Mailing Address:
SUITE 135
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-544-6090
Provider Business Mailing Address Fax Number:
800-886-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 WYOMING ST STE 135
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:
59801-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-370-1377
Provider Business Practice Location Address Fax Number:
800-886-0200
Provider Enumeration Date:
08/26/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAHLUM
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-370-1377

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  432 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1164591046 . This is a "BRENDA NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1316355217 . This is a "KRISTEN NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1558737551 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1578606596 . This is a "RACHEL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: M0110682 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".