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General NPI Number Information
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NPI Number | 1801963004
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC HOUSE CALLS, P.A.
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3310 VALENCIA DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7502
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Country | US
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Telephone | 208-520-4041
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Fax | 208-745-9477
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Provider Business Mailing Address
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Address Line | PO BOX 3914
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3914
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Country | US
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Telephone | 208-520-4041
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Fax | 208-745-9477
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Authorized Official
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Title or Position | CEO
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Name | MR. MARK OSADCHEY
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Credential | R.P.T.
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Telephone | 208-520-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT-1001
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License Number State | ID
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