Organization
HEALTH SPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY PANOS (OWNER)
(208) 215-2030
Entity
Organization
Contact information
Practice address
980 W IRONWOOD DR STE 206, COEUR D ALENE, ID 83814-2668
(208) 215-2030
(208) 400-9537
Mailing address
980 W IRONWOOD DR STE 206, COEUR D ALENE, ID 83814-2668
(208) 215-2030
(208) 400-9537
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
2251S0007X
Sports Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578337044
MULTI-SPECIALTY
ID
Enumeration date
11/14/2023
Last updated
07/02/2026
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