Provider Demographics
NPI:1548312580
Name:ROST, BRIAN MITCHELL (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MITCHELL
Last Name:ROST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SW HIGHWAY 97
Mailing Address - Street 2:STE 200
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-9264
Mailing Address - Country:US
Mailing Address - Phone:406-273-6090
Mailing Address - Fax:
Practice Address - Street 1:1200 S RESERVE ST
Practice Address - Street 2:SUITE H-3
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3105
Practice Address - Country:US
Practice Address - Phone:406-544-2878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1534PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT61518OtherBLUE CROSS - BLUE SHIELD
MT000050595Medicare ID - Type Unspecified