Organization
HIGHLAND PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY SCHWARZE MPT (OWNER)
(208) 237-2080
Entity
Organization
Contact information
Practice address
1951 BENCH RD, SUITE E, POCATELLO, ID 83201
(208) 237-2080
(208) 237-1084
Mailing address
1940 S BONITO WAY STE 190, MERIDIAN, ID 83642-5618
(208) 287-9420
(208) 287-9426
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010155854
MICHAEL OTTO
ID
01
—
000010155857
JONI VAUGHN POWELL
ID
01
—
000010155953
DALE WHEELWRIGHT
ID
05
—
002682600
—
ID
01
—
1356304737
DALE WHEELWRIGHT NPI
ID
01
—
1558324590
MICHAEL OTTO NPI
ID
01
—
1962465344
JONI VAUGHN POWELL NPI
ID
05
—
805478000
—
ID
05
—
806464000
—
ID
01
—
T9325
HIGHLAND PHYSICAL THERAPY
ID
01
—
TD478
MICHAEL OTTO
ID
01
—
TD480
JONI VAUGHN POWELL
ID
01
—
TD481
DALE WHEELWRIGHT
ID
Enumeration date
11/15/2006
Last updated
02/28/2023
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