Provider Demographics
NPI:1548831357
Name:BITTERROOT PELVIC THERAPY D/B/A WELLSPRING PELVIC HEALTH
Entity type:Organization
Organization Name:BITTERROOT PELVIC THERAPY D/B/A WELLSPRING PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:806-236-3124
Mailing Address - Street 1:179 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2404
Mailing Address - Country:US
Mailing Address - Phone:806-236-3124
Mailing Address - Fax:
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:BUILDING 2, SUITE 232
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7479
Practice Address - Country:US
Practice Address - Phone:406-200-8488
Practice Address - Fax:406-213-3518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty