Organization
LAKE CITY PHYSICAL THERAPY P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHEREE LYNN DIBIASE (OWNER)
(208) 667-1988
Entity
Organization
Contact information
Practice address
2065 W RIVERSTONE DR STE 101, COEUR D ALENE, ID 83814-5699
(208) 667-1988
Mailing address
PO BOX 1180, HAYDEN, ID 83835-1180
(208) 966-4176
(208) 765-5654
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT629
ID
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002793000
—
ID
Enumeration date
04/26/2007
Last updated
04/14/2026
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