Organization
PRIME PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA ANNELAINE VANDYKE (OWNER)
(208) 233-2248
Entity
Organization
Contact information
Practice address
30 S MAPLE ST, BLACKFOOT, ID 83221-2128
(208) 684-0021
Mailing address
30 S MAPLE ST, BLACKFOOT, ID 83221-2128
(208) 684-0021
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
12/20/2021
Last updated
10/15/2025
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