Organization
FILL-IN INTERIM THERAPY SERVICES, PLLC
Active
Other names
Aspire Fitness Physical Therapy, Fits/Fitness Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA LYNN MAHLUM PT (OWNER/MANAGER)
(406) 544-6090
Entity
Organization
Contact information
Practice address
945 WYOMING STREET, SUITE 135, MISSOULA, MT 59801
(406) 544-6090
(800) 886-0200
Mailing address
91 CAMPUS DR, PMB 1217, MISSOULA, MT 59801-4492
(406) 544-6090
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
432
MT
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011000682
MEDICARE PTAN
MT
01
—
1164591046
NPI
MT
Enumeration date
08/13/2015
Last updated
01/10/2022
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