Provider Demographics
NPI:1417796632
Name:DODGE WORKS PT, INC DBA ALPINE PHYSICAL THERAPY
Entity type:Organization
Organization Name:DODGE WORKS PT, INC DBA ALPINE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:VERSTEEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-251-2323
Mailing Address - Street 1:2965 STOCKYARD RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1557
Mailing Address - Country:US
Mailing Address - Phone:406-541-2606
Mailing Address - Fax:
Practice Address - Street 1:2965 STOCKYARD RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1557
Practice Address - Country:US
Practice Address - Phone:406-541-2606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DODGEWORKS PT, INC. DBA ALPINE PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7134441Medicaid