MEDICARE: ALTITUDE PHYSICAL THERAPY, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619045309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTITUDE PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	2721 S 10TH AVE STE 105
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-5792
Country	:	US
Telephone Number	:	208-454-9839
Fax Number	:	208-454-0727

Provider Business Practice Location Address
First Line	:	2721 S 10TH AVE STE 105
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-5792
Country	:	US
Telephone Number	:	208-454-9839
Fax Number	:	208-454-0727

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SEAN R WEATHERSTON
Credential	:	PT
Telephone Number	:	208-454-9839

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	01/13/2026

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