Organization
VALLEY VISTA THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY KENNELLY (CORPORATE COMPLIANCE MANAGER)
(208) 245-4576
Entity
Organization
Contact information
Practice address
820 ELM ST, ST MARIES, ID 83861-2119
(208) 245-4576
(208) 245-5909
Mailing address
820 ELM ST, ST MARIES, ID 83861-2119
(208) 245-4576
(208) 245-5909
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
OT-061
ID
2083X0100X
Occupational Medicine Physician
OT-510
ID
235Z00000X
Speech-Language Pathologist
Primary
SLP-1123
ID
261QP2000X
Physical Therapy Clinic/Center
PT-160
ID
Other
Enumeration date
06/18/2007
Last updated
09/11/2025
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