NPIMap

Organization Active NPI

Lone Peak Physical Therapy, Inc.

  • Occupational Therapist
  • Bozeman, MT
National Provider Identifier
1619305752
Registry record updated Mar 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OTPOTLIC997 Issued in MT
Legal business name
LONE PEAK PHYSICAL THERAPY, INC.
Practice address
630 Boardwalk Ave Ste 1
Bozeman, MT 59718-4118
Phone
(406) 548-6266
Fax
(406) 548-6269
NPI assigned
Oct 29, 2013
Last updated
Mar 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2019

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

Authorized official

Name
Jamey Kabisch
Title
Cfo
Phone
(406) 223-0478

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PTPPTLIC1729 MT
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OTPOTLIC997 MT Primary

Addresses

Primary practice location

630 Boardwalk Ave Ste 1
Bozeman, MT 59718-4118

Mailing address

630 Boardwalk Ave Ste 1
Bozeman, MT 59718-4118
Phone (406) 548-6266

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000719 MT Part B Supplier - Clinic/Group Practice 5193637262 Receives reassigned benefits from 64 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bozeman, MT; Helena, MT; Butte, MT; Billings, MT; Big Sky, MT; Belgrade, MT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

630 Boardwalk Ave
Ste 1
Bozeman, MT 59718
Phone (406) 548-6266

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553040000000",
    "number": "1619305752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 BOARDWALK AVE STE 1",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597184118",
            "telephone_number": "406-548-6266",
            "fax_number": "406-548-6269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 BOARDWALK AVE STE 1",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597184118",
            "telephone_number": "406-548-6266",
            "fax_number": "406-548-6269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONE PEAK PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2019-03-20",
        "status": "A",
        "authorized_official_last_name": "KABISCH",
        "authorized_official_first_name": "JAMEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "406-223-0478"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "PTPPTLIC1729",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "MT",
            "license": "OTPOTLIC997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; 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.