Organization
LONE PEAK PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN C BOERSMA MPT (OWNER/PRESIDENT)
(406) 995-7525
Entity
Organization
Contact information
Practice address
630 BOARDWALK AVE STE 1, BOZEMAN, MT 59718-4118
(406) 548-6266
(406) 548-6269
Mailing address
PO BOX 11629, BOZEMAN, MT 59719-1629
(406) 522-7488
(406) 522-7487
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000083080
MEDICARE PTAN
MT
05
—
1477678969
—
MT
Enumeration date
05/07/2015
Last updated
11/03/2021
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