Healthcare Provider Details

I. General information

NPI: 1053668970
Provider Name (Legal Business Name): THAYN PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 NORTH HIGHWAY 93
CHALLIS ID
83226
US

IV. Provider business mailing address

PO BOX 707
CHALLIS ID
83226-0707
US

V. Phone/Fax

Practice location:
  • Phone: 208-859-9570
  • Fax:
Mailing address:
  • Phone: 208-859-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2402
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 2402
License Number StateID

VIII. Authorized Official

Name: ZHOHNANN KATHLEEN PIVA THAYN
Title or Position: PHYSICAL THERAPIST
Credential: D.P.T
Phone: 208-859-9570