Healthcare Provider Details

I. General information

NPI: 1134149941
Provider Name (Legal Business Name): RIVER CITY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 E POLSTON AVE
POST FALLS ID
83854
US

IV. Provider business mailing address

1132 E POLSTON AVE
POST FALLS ID
83854-6045
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-7800
  • Fax: 208-777-9209
Mailing address:
  • Phone: 208-777-7800
  • Fax: 208-777-9209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRISH ORTEGA
Title or Position: OFFICE MANAGER
Credential:
Phone: 208-777-7800