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General NPI Number Information
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NPI Number | 1073956306
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Entity Type | Organization
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Legal Business Name | PT MEDICAL LLC
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Dates
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Enumeration Date | 04/17/2013
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 490 MEMORIAL DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3656
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Country | US
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Telephone | 630-364-8144
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Fax | 866-661-4322
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Provider Business Mailing Address
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Address Line | PO BOX 51630
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City | IDAHO FALLS
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State | ID
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Zip | 83405-1630
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Country | US
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Telephone | 630-364-8144
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Fax | 866-661-4322
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | STEPHEN BIRD
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Credential |
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Telephone | 630-364-8144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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