1043392087 NPI number — INSTITUTE OF PHYSICAL THERAPY AND FITNESS

Table of content: (NPI 1043392087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043392087 NPI number — INSTITUTE OF PHYSICAL THERAPY AND FITNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE OF PHYSICAL THERAPY AND FITNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043392087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
678 SOUTHWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83501-3783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-746-1418
Provider Business Mailing Address Fax Number:
208-746-4123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
678 SOUTHWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83501-3783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-746-1418
Provider Business Practice Location Address Fax Number:
208-746-4123
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OHMAN
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
208-746-1418

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8B263 . This is a "BCID GROUP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0112038 . This is a "WA LI" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 650006220 . This is a "RR MEDICARE" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 390090 . This is a "REGENCE GROUP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1000927 . This is a "CHAMPUS/BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 7023864 . This is a "WAPA GROUP" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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