Provider Demographics
NPI:1306301601
Name:406 PHYSICAL THERAPY
Entity type:Organization
Organization Name:406 PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-829-2399
Mailing Address - Street 1:5207 FRAZER CT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-9505
Mailing Address - Country:US
Mailing Address - Phone:406-546-6764
Mailing Address - Fax:
Practice Address - Street 1:725 SW HIGGINS AVE STE D
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1420
Practice Address - Country:US
Practice Address - Phone:406-493-0877
Practice Address - Fax:406-493-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy