# CHANNING PHYSICAL THERAPY PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306064910
- **Authorized official:** MS. MEISHA ADAMS (BILLING MANAGER)
- **Authorized official phone:** (208) 529-8005

## Contact information

- **Practice address:** 2570 CHANNING WAY, IDAHO FALLS, ID 83404-7515
- **Practice address phone:** (208) 529-8005
- **Mailing address:** 2570 CHANNING WAY, IDAHO FALLS, ID 83404-7515
- **Mailing address phone:** (208) 529-8005

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | NULL | Yes |
| 174400000X | Specialist | — | — | Yes |

## Other

- **Enumeration date:** 04/22/2007
- **Last updated:** 06/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 39012 | BS OF IDAHO GROUP ID\# | ID |
| 05 | — | 805633700 | — | ID |
| 01 | — | T-097-3 | BC OF IDAHO GROUP ID\# | ID |