Provider Demographics
NPI:1538546965
Name:MILESTONE FUNCTIONAL RESTORATION
Entity type:Organization
Organization Name:MILESTONE FUNCTIONAL RESTORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-752-2438
Mailing Address - Street 1:300 1ST AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4834
Mailing Address - Country:US
Mailing Address - Phone:406-752-2438
Mailing Address - Fax:406-752-2367
Practice Address - Street 1:300 1ST AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4834
Practice Address - Country:US
Practice Address - Phone:406-752-2438
Practice Address - Fax:406-752-2367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy