MEDICARE: MOUNTAIN HOME PHYSICAL THERAPY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1134251507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN HOME PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	230 E 5TH N
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2749
Country	:	US
Telephone Number	:	208-587-8944
Fax Number	:	208-587-6105

Provider Business Practice Location Address
First Line	:	230 E 5TH N
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2749
Country	:	US
Telephone Number	:	208-587-8944
Fax Number	:	208-587-6105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT W SESSIONS
Credential	:
Telephone Number	:	208-587-8944

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	03/02/2015

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