Provider Demographics
NPI:1548483837
Name:MOUNTAIN PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:MOUNTAIN PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:II
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:406-755-5754
Mailing Address - Street 1:1297 BURNS WAY STE 3
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3162
Mailing Address - Country:US
Mailing Address - Phone:406-755-5754
Mailing Address - Fax:
Practice Address - Street 1:1297 BURNS WAY STE 3
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3162
Practice Address - Country:US
Practice Address - Phone:406-755-5754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty