Provider Demographics
NPI:1033726880
Name:MOSCOW PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:MOSCOW PHYSICAL THERAPY, LLC
Other - Org Name:PEAK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-314-5904
Mailing Address - Street 1:1174 ALTURAS DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843
Mailing Address - Country:US
Mailing Address - Phone:208-375-0666
Mailing Address - Fax:208-375-2996
Practice Address - Street 1:1174 ALTURAS DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843
Practice Address - Country:US
Practice Address - Phone:208-375-0666
Practice Address - Fax:208-375-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy