1881938777 NPI number — NORTH STAR PHYSICAL THERAPY AND WELLNESS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881938777 NPI number — NORTH STAR PHYSICAL THERAPY AND WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH STAR PHYSICAL THERAPY AND WELLNESS
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:
1881938777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8944 N. HESS ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HAYDEN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83835-9691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-762-0251
Provider Business Mailing Address Fax Number:
208-762-0252

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8944 N. HESS ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HAYDEN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-762-0251
Provider Business Practice Location Address Fax Number:
208-762-0252
Provider Enumeration Date:
11/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
208-659-6327

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT1877 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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