Provider Demographics
NPI:1588110977
Name:ASPIRE FITNESS PHYSICAL THERAPY
Entity type:Organization
Organization Name:ASPIRE FITNESS PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-370-1377
Mailing Address - Street 1:945 WYOMING STREET
Mailing Address - Street 2:SUITE 135
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-544-6090
Mailing Address - Fax:800-886-0200
Practice Address - Street 1:945 WYOMING ST STE 135
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-1929
Practice Address - Country:US
Practice Address - Phone:406-370-1377
Practice Address - Fax:800-886-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FILL-IN INTERIM THERAPY SERVICES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-26
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MT432261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164591046OtherBRENDA NPI
1316355217OtherKRISTEN NPI
1558737551OtherNPI
1578606596OtherRACHEL NPI
MTM0110682Medicaid