1821502204 NPI number — ACTION POINT PHYSICAL THERAPY LLC

Table of content: (NPI 1821502204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821502204 NPI number — ACTION POINT PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTION POINT PHYSICAL THERAPY LLC
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:
1821502204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDPOINT
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83864-0915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-284-3597
Provider Business Mailing Address Fax Number:
208-718-6341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 N FIFTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDPOINT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83864-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-284-3597
Provider Business Practice Location Address Fax Number:
208-718-6341
Provider Enumeration Date:
11/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
VANDERFORD
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
208-255-8364

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT-2378 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1770747404 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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