NPIMap

Organization Active NPI

Three Forks Physical Therapy, Inc.

  • Physical Therapy Clinic/Center
  • Three Forks, MT
National Provider Identifier
1376678037
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1278 Issued in MT
Legal business name
THREE FORKS PHYSICAL THERAPY, INC.
Practice address
203 S Main St.
Three Forks, MT 59752
Phone
(406) 285-0626
Fax
(406) 285-3500
NPI assigned
Feb 22, 2007
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Authorized official

Name
Mrs. Nicole Colleen Hecock, P.T.NPI 1053432575
Title
President
Phone
(406) 285-0626

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 1278 MT Primary

Addresses

Primary practice location

203 S Main St.
Three Forks, MT 59752

Mailing address

PO Box 1180
Three Forks, MT 59752-1180
Phone (406) 285-0626

Other identifiers 2

IdentifierTypeStateIssuer
000061916OtherMTBLUE CROSS BLUE SHIELD
0345032MedicaidMT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080612000842 MT Part B Supplier - Clinic/Group Practice 3173694544 Receives reassigned benefits from 2 practitioners
Practice locations: Three Forks, MT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1376678037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1180",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597521180",
            "telephone_number": "406-285-0626",
            "fax_number": "406-285-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S MAIN ST.",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "59752",
            "telephone_number": "406-285-0626",
            "fax_number": "406-285-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE FORKS PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "HECOCK",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "COLLEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "406-285-0626",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MT",
            "license": "1278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000061916",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0345032",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Three Forks, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.