Provider Demographics
NPI:1033678180
Name:ALL SEASONS THERAPY
Entity Type:Organization
Organization Name:ALL SEASONS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ADELFA
Authorized Official - Last Name:FULLER ZURENDA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:406-521-0052
Mailing Address - Street 1:1305 LYN DR
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-3661
Mailing Address - Country:US
Mailing Address - Phone:406-521-0052
Mailing Address - Fax:
Practice Address - Street 1:1305 LYN DR
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-3661
Practice Address - Country:US
Practice Address - Phone:406-521-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No251E00000XAgenciesHome Health