Organization
PRIMARY THERAPY SOURCE LLC
Active
Parent organization
PRIMARY THERAPY SOURCE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRIMARY THERAPY SOURCE LLC
Authorized official
JAN YINGST PT (OWNER)
(208) 734-7333
Entity
Organization
Contact information
Practice address
254 RIVER VISTA PL, TWIN FALLS, ID 83301-3006
(208) 734-7333
(208) 734-8350
Mailing address
254 RIVER VISTA PL, TWIN FALLS, ID 83301-3006
(208) 734-7333
(208) 734-8350
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
08/18/2008
Last updated
08/18/2008
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