Provider Demographics
NPI:1962532846
Name:MONTANA SPINE & JOINT REHAB, INC
Entity type:Organization
Organization Name:MONTANA SPINE & JOINT REHAB, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SHAREHOLDER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-443-1122
Mailing Address - Street 1:2748 COLONIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4947
Mailing Address - Country:US
Mailing Address - Phone:406-443-1122
Mailing Address - Fax:406-443-1144
Practice Address - Street 1:2748 COLONIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4947
Practice Address - Country:US
Practice Address - Phone:406-443-1122
Practice Address - Fax:406-443-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT1068225100000X
MTMT1243261QP2000X
MTMT1481261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1962532846Medicaid
MT1962532846OtherNPI # FOR THE GROUP