NPI |
1902473952 |
|
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
Provider Organization Name Legal Business Name |
MOVE MORE PERFORMANCE - WELLNESS - REHAB |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Other Organization Name |
INTEGRATED REHAB |
Other name by which the organization provider is or has been known. |
Provider Other Organization Name Type Code |
3 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Provider First Line Business Practice Location Address |
1595 GRAND AVE STE 200 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
BILLINGS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MT |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
591023055 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Country Code If outside U S |
US |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Telephone Number |
3072171067 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Business Practice Location Address Fax Number |
4065343396 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Enumeration Date |
6/8/2021 |
The city name in the location address of the provider being identified. |
Last Update Date |
9/14/2021 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
WITTY |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
WYATT |
The first name of the authorized official. |
Authorized Official Title or Position |
OWNER/CEO |
The title or position of the authorized official. |
Authorized Official Telephone Number |
3072171067 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QP2000X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
DR. |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Authorized Official Credential Text |
PT, DPT |
|
NPI Certification Date |
9/14/2021 |
|