Healthcare Provider Details

I. General information

NPI: 1528101961
Provider Name (Legal Business Name): JOHANNA MAE STREHLE MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 21ST ST
LEWISTON ID
83501-3415
US

IV. Provider business mailing address

1023 21ST ST
LEWISTON ID
83501-3415
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-1795
  • Fax: 208-743-1971
Mailing address:
  • Phone: 208-743-1795
  • Fax: 208-743-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License NumberPT-1861
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: