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General NPI Number Information
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NPI Number | 1366799827
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY CLINIC,INC.
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 802 SHOUP STREET
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City | SALMON
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State | ID
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Zip | 83467
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Country | US
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Telephone | 208-756-2005
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Fax | 208-756-4020
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | SALMON
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State | ID
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Zip | 83467-1107
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Country | US
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Telephone | 208-756-2005
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Fax | 208-756-4020
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | ZHOHNANN THAYN
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Credential | P.T.
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Telephone | 208-756-2005
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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 | PT 92
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License Number State | ID
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