| Organization Name: | LOLO PHYSICAL THERAPY PC |
| NPI Number: | 1295047371 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL R SANDRY (DIRECTOR) |
| Mailing Address: | 106 Tyler Way Lolo |
| State: | MT US |
| Postal Code: | 598479714 |
| Phone Number: | 4062733730 |
| Fax Number: | 4062739088 |
| NPI Enumeration Date: | 07/06/2010 |
| NPI Last Update Date: | 10/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 1263MT |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |