Provider Demographics
NPI:1538840657
Name:MONTANA CORE PHYSIO
Entity type:Organization
Organization Name:MONTANA CORE PHYSIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:858-900-8108
Mailing Address - Street 1:233 EDELWEISS DR UNIT 10A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3935
Mailing Address - Country:US
Mailing Address - Phone:406-595-1920
Mailing Address - Fax:
Practice Address - Street 1:233 EDELWEISS DR UNIT 10A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3935
Practice Address - Country:US
Practice Address - Phone:406-595-1920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy