Provider Demographics
NPI:1114358801
Name:ENDURANCE CYCLING STUDIO & PHYSICAL THERAPY
Entity type:Organization
Organization Name:ENDURANCE CYCLING STUDIO & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-624-9294
Mailing Address - Street 1:2493 BOYLAN RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1525
Mailing Address - Country:US
Mailing Address - Phone:406-624-9294
Mailing Address - Fax:
Practice Address - Street 1:317 GALLATIN PARK DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-7909
Practice Address - Country:US
Practice Address - Phone:406-624-9294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4333261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy