| NPI | 1558737551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LYNN MAHLUM Owner/Manager 406-544-6090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 432) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2022-01-10 |