Organization
GATE CITY PHYSICAL THERAPY
Active
Organization
GATE CITY PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL E OTTO PT (OWNER)
(208) 237-2080
Entity
Organization
Contact information
Practice address
1951 BENCH RD, SUITE E, POCATELLO, ID 83201-2073
(208) 237-2080
(208) 237-1084
Mailing address
1951 BENCH RD, SUITE E, POCATELLO, ID 83201-2073
(208) 237-2080
(208) 237-1084
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT-186
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T0890
BLUE CROSS
ID
Enumeration date
03/27/2007
Last updated
08/22/2020
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