Provider Demographics
NPI:1871069450
Name:AMY SLABAUGH PHYSICAL THERAPY & MASSAGE THERAPY LLC
Entity type:Organization
Organization Name:AMY SLABAUGH PHYSICAL THERAPY & MASSAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, LMT
Authorized Official - Phone:406-599-1608
Mailing Address - Street 1:6111 SHADOW CIR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8384
Mailing Address - Country:US
Mailing Address - Phone:406-599-1608
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5806
Practice Address - Country:US
Practice Address - Phone:406-599-1608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty