Organization
PHYSICAL THERAPY PLUS OF IDAHO PLLC
Active
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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