Healthcare Provider Details

I. General information

NPI: 1063218444
Provider Name (Legal Business Name): SELKIRK PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N FIFTH AVE
SANDPOINT ID
83864-1520
US

IV. Provider business mailing address

483 WOODLAND DR
SANDPOINT ID
83864-7211
US

V. Phone/Fax

Practice location:
  • Phone: 208-297-1570
  • Fax: 208-593-3097
Mailing address:
  • Phone: 815-980-0269
  • Fax: 208-593-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KENNETH G FISCHER
Title or Position: OWNER
Credential: DPT
Phone: 208-297-1570