Organization
OTTER SLIDE PEDIATRIC PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY S EVERSOLE PT, DPT (PHYSICAL THERAPIST)
(406) 312-9967
Entity
Organization
Contact information
Practice address
135 FAIRWAY DR, MISSOULA, MT 59803-2404
(406) 312-9967
(406) 519-5542
Mailing address
PO BOX 474, MISSOULA, MT 59806-0474
(406) 312-9967
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
07/10/2024
Last updated
11/20/2024
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