Organization
LOLO PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL RAFE SANDRY P.T. (OWNER PHYSICAL THERAPIST)
(406) 273-3730
Entity
Organization
Contact information
Practice address
106 TYLER WAY, LOLO, MT 59847-9714
(406) 273-3730
(406) 273-9088
Mailing address
PO BOX 1627, LOLO, MT 59847-1627
(406) 273-3730
(406) 273-9088
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1263PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000342363
—
MT
Enumeration date
06/06/2007
Last updated
11/08/2007
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