Organization
LOLO PHYSICAL THERAPY PLLC
Active
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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