Organization
EAGLE PHYSICAL THERAPY & SPORTS MED
Active
Organization
EAGLE PHYSICAL THERAPY & SPORTS MED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRANT D POOR MSPT (OWNER)
(406) 467-3800
Entity
Organization
Contact information
Practice address
15 6TH ST S, FAIRFIELD, MT 59436
(406) 467-3800
(406) 467-3828
Mailing address
PO BOX 457, 15 6TH ST S, FAIRFIELD, MT 59436-0457
(406) 467-3800
(406) 467-3828
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1258
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1194740928
MEDICARE NPI
MT
Enumeration date
04/22/2015
Last updated
04/22/2015
Update your record
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