Organization
K4JPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN GREEN (BUSINESS MANAGER)
(406) 771-0777
Entity
Organization
Contact information
Practice address
2517 7TH AVE S, SUITE A-1, GREAT FALLS, MT 59405-3032
(406) 771-0777
(406) 771-0776
Mailing address
2517 7TH AVE S, SUITE A-1, GREAT FALLS, MT 59405-3032
(406) 771-0777
(406) 771-0776
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
591
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA5315
RAILROAD MEDICARE
MT
Enumeration date
10/25/2007
Last updated
10/25/2007
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