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General NPI Number Information
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NPI Number | 1184717696
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY & SPORTS MEDICINE INSTITUTE INC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 850 W IRONWOOD DR SUITE 103
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4903
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Country | US
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Telephone | 208-664-1119
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Fax | 208-765-4340
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Provider Business Mailing Address
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Address Line | PO BOX 609
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City | HAYDEN
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State | ID
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Zip | 83835-0609
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Country | US
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Telephone | 208-664-1119
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Fax | 208-765-4340
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MICHAEL A WHITING
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Credential | PT
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Telephone | 208-664-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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