| |
701 W Spruce St, Missoula, MT 59802-3904 | |
(406) 721-8858 | |
(406) 542-0960 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 701 W Spruce St, Missoula, Montana |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1437331063 | NPI | - | NPPES |
000061750 | Other | MT | BLUE CROSS BLUE SHIELD |
000060776 | Other | MT | BLUE CROSS |
0000344097 | Medicaid | MT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | 257 (Montana) | Primary |
Provider Name | Tim J Cordial |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1538134952 PECOS PAC ID: 8224119276 Enrollment ID: I20080115000766 |
Mailing Address | Practice Location Address |
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701 W Spruce St, Missoula, MT 59802-3904 Ph: (406) 721-8858 | 701 W Spruce St, Missoula, MT 59802-3904 Ph: (406) 721-8858 |