Organization
PERFORMANCE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE LIDDLE MPT (OWNER/MANAGER)
(208) 521-5691
Entity
Organization
Contact information
Practice address
3125 VALENCIA DR, IDAHO FALLS, ID 83404-7575
(208) 529-3332
Mailing address
1940 S BONITO WAY STE 190, MERIDIAN, ID 83642-5618
(208) 287-9420
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-954
ID
335E00000X
Prosthetic/Orthotic Supplier
DME14657
ID
Other
Enumeration date
04/26/2010
Last updated
03/14/2023
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