Organization
IDAHO PEDIATRIC THERAPY CLINIC PLLC
Active
Organization
IDAHO PEDIATRIC THERAPY CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LONGORIA (OFFICE MANAGER)
(208) 939-3334
Entity
Organization
Contact information
Practice address
3080 E GENTRY WAY STE 180, MERIDIAN, ID 83642-3544
(208) 939-3334
(208) 939-1122
Mailing address
3080 E GENTRY WAY STE 180, MERIDIAN, ID 83642-3544
(089) 393-3342
(208) 939-1122
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1450
ID
225X00000X
Occupational Therapist
OT-928
ID
235Z00000X
Speech-Language Pathologist
SLP-2249
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013086610
—
ID
05
—
1194125617
—
ID
Enumeration date
09/03/2014
Last updated
07/09/2019
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up