1053668970 NPI number — THAYN PHYSICAL THERAPY, PLLC

Table of content: HEATHER RACHELLE WHITE PT (NPI 1871061119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053668970 NPI number — THAYN PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THAYN PHYSICAL THERAPY, PLLC
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:
THAYN PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
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:
1053668970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 707
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHALLIS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83226-0707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-859-9570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
510 NORTH HIGHWAY 93
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHALLIS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-859-9570
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THAYN
Authorized Official First Name:
ZHOHNANN
Authorized Official Middle Name:
KATHLEEN PIVA
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
208-859-9570

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 2402 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X , with the licence number: PT 2402 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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