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Organization

INSTITUTE OF PHYSICAL THERAPY AND FITNESS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. PEGGY E OHMAN (BUSINESS MANAGER)
(208) 746-1418
Entity
Organization

Contact information

Practice address
678 SOUTHWAY AVE, LEWISTON, ID 83501-3783
(208) 746-1418
(208) 746-4123
Mailing address
678 SOUTHWAY AVE, LEWISTON, ID 83501-3783
(208) 746-1418
(208) 746-4123

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0112038
WA LI
ID
01
1000927
CHAMPUS/BLUE CROSS
ID
01
390090
REGENCE GROUP
ID
01
650006220
RR MEDICARE
ID
01
7023864
WAPA GROUP
ID
01
8B263
BCID GROUP
ID
Enumeration date
10/19/2006
Last updated
10/19/2011
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