Healthcare Provider Details

I. General information

NPI: 1326935321
Provider Name (Legal Business Name): REALIZE PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 4TH AVE STE 103
SANDPOINT ID
83864-1360
US

IV. Provider business mailing address

1611 LARCH ST
SANDPOINT ID
83864-2156
US

V. Phone/Fax

Practice location:
  • Phone: 208-610-7134
  • Fax: 208-627-4184
Mailing address:
  • Phone: 208-610-7134
  • Fax: 208-627-4184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BLOMQUIST
Title or Position: OWNER
Credential: PT, DPT
Phone: 208-610-7134