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General NPI Number Information
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NPI Number | 1790380822
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Entity Type | Organization
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Legal Business Name | HOMETOWN PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 12/04/2020
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 245 MAIN ST
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City | RIRIE
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State | ID
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Zip | 83443
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Country | US
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Telephone | 208-390-1793
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 273
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City | RIRIE
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State | ID
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Zip | 83443-0273
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Country | US
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Telephone | 208-900-6336
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Fax | 208-900-4408
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | CHAD SIMMONS
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Credential |
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Telephone | 208-390-1793
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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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