=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366698003
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARIBOU PHYSICAL THERAPY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2008
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 47390 HIGHWAY 200
-----------------------------------------------------
City | HOPE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83836-9647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-265-8333
-----------------------------------------------------
Fax | 208-263-1394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 ROUNDHOUSE CIR
-----------------------------------------------------
City | SANDPOINT
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83864-8674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-265-8333
-----------------------------------------------------
Fax | 208-263-1394
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER/PROVIDER
-----------------------------------------------------
Name | PAULA AMY LUND
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 208-265-8333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 225100000X
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------