MEDICARE: ENHANCED PHYSICAL THERAPY PLLC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1225734700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENHANCED PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	9 N BRIDGE ST
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-2110
Country	:	US
Telephone Number	:	208-600-6282
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 N BRIDGE ST
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-2110
Country	:	US
Telephone Number	:	208-600-6282
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER/BILLING SPECIALIST
Name	:	MEGAN NYE
Credential	:
Telephone Number	:	208-600-6282

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	02/16/2023

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