Organization
THE CENTER OF PHYSICAL THERAPY & WELLNESS
Active
Other names
Balanced Physical Therapy & Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLEY ANN SULLIVAN P.T. (OWNER/PRESIDENT)
(406) 542-6670
Entity
Organization
Contact information
Practice address
1515 S RUSSELL ST, MISSOULA, MT 59801-3629
(406) 542-6670
(406) 542-5496
Mailing address
1515 S RUSSELL ST, MISSOULA, MT 59801-3629
(406) 542-6670
(406) 542-5496
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
786PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000060648
BCBS
MT
01
—
CK2066
RR MEDICARE GROUP
MT
01
—
MSF1176897
BUS. STATE FUND
MT
Enumeration date
10/20/2006
Last updated
06/19/2008
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