Provider Demographics
NPI:1902050123
Name:HIGH MOUNTAIN FITNESS PHYSICAL THERAPY & PILATES LLC
Entity type:Organization
Organization Name:HIGH MOUNTAIN FITNESS PHYSICAL THERAPY & PILATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:307-335-7678
Mailing Address - Street 1:669 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3033
Mailing Address - Country:US
Mailing Address - Phone:307-335-7678
Mailing Address - Fax:
Practice Address - Street 1:669 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3033
Practice Address - Country:US
Practice Address - Phone:307-335-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty