# TRI-CITY PHYSICAL THERAPY, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tir-City Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093864282
- **Authorized official:** MR. CODY DEE STEPHENS P.T. (OWNER/PRESIDENT)
- **Authorized official phone:** (208) 452-6366

## Contact information

- **Practice address:** 215 N. WHITLEY DRIVE, SUITE 1, FRUITLAND, ID 83619-2706
- **Practice address phone:** (208) 452-6366
- **Practice address fax:** (208) 452-6399
- **Mailing address:** 215 N. WHITLEY DRIVE, SUITE 1, FRUITLAND, ID 83619-2706
- **Mailing address phone:** (208) 452-6366
- **Mailing address fax:** (208) 452-6399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | NULL | Yes |
| 174400000X | Specialist | — | — | Yes |
| 225100000X | Physical Therapist | RPT550 | ID | — |

## Other

- **Enumeration date:** 01/09/2007
- **Last updated:** 05/21/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 806639200 | — | ID |