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General NPI Number Information
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NPI Number | 1033726880
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Entity Type | Organization
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Legal Business Name | MOSCOW PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 1174 ALTURAS DRIVE SUITE 2
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City | MOSCOW
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State | ID
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Zip | 83843
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Country | US
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Telephone | 208-375-0666
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Fax | 208-375-2996
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Provider Business Mailing Address
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Address Line | 1174 ALTURAS DRIVE SUITE 2
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City | MOSCOW
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State | ID
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Zip | 83843
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Country | US
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Telephone | 208-375-0666
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Fax | 208-375-2996
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SHELLIE M MCCARTHY
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Credential |
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Telephone | 208-314-5904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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