Individual
ZACHARY PORTER LASALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
734 9TH ST W STE 12, COLUMBIA FALLS, MT 59912-3858
(406) 471-2022
Mailing address
126 EMPIRE LOOP, KALISPELL, MT 59901-2523
(406) 471-2022
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1868
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M011000800
PTAN
MT
Enumeration date
04/10/2007
Last updated
11/08/2011
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