NPIMap

Organization Active NPI

The Center of Physical Therapy & Wellness

  • Physical Therapy Clinic/Center
  • Missoula, MT
National Provider Identifier
1104908805
Registry record updated Jun 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
786PT Issued in MT
Legal business name
THE CENTER OF PHYSICAL THERAPY & WELLNESS
Practice address
1515 S Russell St
Missoula, MT 59801-3629
Phone
(406) 542-6670
Fax
(406) 542-5496
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Shelley Ann Sullivan, P.T.NPI 1710060918
Title
Owner/President
Phone
(406) 542-6670

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 786PT MT Primary

Addresses

Primary practice location

1515 S Russell St
Missoula, MT 59801-3629

Mailing address

1515 S Russell St
Missoula, MT 59801-3629
Phone (406) 542-6670

Other identifiers 3

IdentifierTypeStateIssuer
MSF1176897OtherMTBUS. STATE FUND
CK2066OtherMTRR MEDICARE GROUP
000060648OtherMTBCBS

Other names 1

  • Balanced Physical Therapy & Wellness Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Balanced Physical Therapy Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1104908805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 S RUSSELL ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598013629",
            "telephone_number": "406-542-6670",
            "fax_number": "406-542-5496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 S RUSSELL ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598013629",
            "telephone_number": "406-542-6670",
            "fax_number": "406-542-5496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CENTER OF PHYSICAL THERAPY & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "406-542-6670",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MT",
            "license": "786PT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUS. STATE FUND",
            "identifier": "MSF1176897",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CK2066",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000060648",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Balanced Physical Therapy & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.