Provider Demographics
NPI:1699235564
Name:PELVIS SPINE & SPORT PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PELVIS SPINE & SPORT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:406-471-0464
Mailing Address - Street 1:35 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4448
Mailing Address - Country:US
Mailing Address - Phone:406-471-0464
Mailing Address - Fax:406-260-4796
Practice Address - Street 1:35 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4448
Practice Address - Country:US
Practice Address - Phone:406-471-0464
Practice Address - Fax:406-260-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy