Organization
COEUR D ALENE PHYSICAL THERAPY AND SPORTS MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY F BARTOO PT (OWNER)
(208) 667-3583
Entity
Organization
Contact information
Practice address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 667-3583
(208) 667-2643
Mailing address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 667-3583
(208) 667-2643
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006968
REGENCE BLUE SHIELD OF ID
ID
05
—
002711200
—
ID
01
—
T0726
BLUE CROSS OF IDAHO
ID
Enumeration date
03/01/2006
Last updated
10/28/2015
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