MEDICARE: AT HOME PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1743	ID

General Provider Information

NPI Number	:	1154481455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	1459 W YAQUINA DR
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5190
Country	:	US
Telephone Number	:	208-661-6366
Fax Number	:	208-773-5653

Provider Business Practice Location Address
First Line	:	1459 W YAQUINA DR
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-5190
Country	:	US
Telephone Number	:	208-661-6366
Fax Number	:	208-773-5653

Authorized Official
Title or Position	:	PT OWNER
Name	:	BRETT BARNA
Credential	:	P.T.
Telephone Number	:	208-661-6366

Provider Enumeration Date	:	12/10/2006
Last Update Date	:	08/22/2020

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