Provider Demographics
NPI:1093069205
Name:HOBBY HORSE PLACE LLC
Entity type:Organization
Organization Name:HOBBY HORSE PLACE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGUINNESS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-270-4697
Mailing Address - Street 1:PO BOX 1743
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-1743
Mailing Address - Country:US
Mailing Address - Phone:406-270-4697
Mailing Address - Fax:406-578-8373
Practice Address - Street 1:40490 BAYPOINT ROAD
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860
Practice Address - Country:US
Practice Address - Phone:406-270-4697
Practice Address - Fax:406-578-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1093069205Medicaid