Healthcare Provider Details

I. General information

NPI: 1265941108
Provider Name (Legal Business Name): INSPIRE PHYSICAL THERAPY IDAHO INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 N NORTHWOOD CENTER CT STE B
COEUR D ALENE ID
83814-4944
US

IV. Provider business mailing address

100 DENNIS ST SW STE B
TUMWATER WA
98501-6523
US

V. Phone/Fax

Practice location:
  • Phone: 208-665-7055
  • Fax: 208-665-7093
Mailing address:
  • Phone: 208-665-7055
  • Fax: 208-665-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY PROVOZNIK
Title or Position: VP OPERATIONS
Credential:
Phone: 360-338-0181