Organization
PHYSICAL THERAPY PLUS OF IDAHO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SYDNEY LYN PRAEGER RPT (OWNER PARTNER)
(208) 725-5185
Entity
Organization
Contact information
Practice address
180 W 1ST ST, #101, KETCHUM, ID 83340
(208) 725-5185
(208) 725-5192
Mailing address
PO BOX 2182, 180 W 1ST ST #101, KETCHUM, ID 83340-2182
(208) 725-5185
(208) 725-5192
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805993300
—
ID
01
—
CB2679
RAILROAD MC
—
01
—
HCFAT9511
BLUE CROSS
ID
Enumeration date
01/11/2006
Last updated
10/28/2011
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