Organization
TRI-CITY PHYSICAL THERAPY, P.C.
Active
Other names
Tir-City Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CODY DEE STEPHENS P.T. (OWNER/PRESIDENT)
(208) 452-6366
Entity
Organization
Contact information
Practice address
215 N. WHITLEY DRIVE, SUITE 1, FRUITLAND, ID 83619-2706
(208) 452-6366
(208) 452-6399
Mailing address
215 N. WHITLEY DRIVE, SUITE 1, FRUITLAND, ID 83619-2706
(208) 452-6366
(208) 452-6399
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
225100000X
Physical Therapist
RPT550
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806639200
—
ID
Enumeration date
01/09/2007
Last updated
05/21/2013
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