Provider Demographics
NPI:1043392087
Name:INSTITUTE OF PHYSICAL THERAPY AND FITNESS
Entity Type:Organization
Organization Name:INSTITUTE OF PHYSICAL THERAPY AND FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:E
Authorized Official - Last Name:OHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-746-1418
Mailing Address - Street 1:678 SOUTHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3783
Mailing Address - Country:US
Mailing Address - Phone:208-746-1418
Mailing Address - Fax:208-746-4123
Practice Address - Street 1:678 SOUTHWAY AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3783
Practice Address - Country:US
Practice Address - Phone:208-746-1418
Practice Address - Fax:208-746-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8B263OtherBCID GROUP
ID0112038OtherWA LI
ID650006220OtherRR MEDICARE
ID390090OtherREGENCE GROUP
ID1000927OtherCHAMPUS/BLUE CROSS
ID7023864OtherWAPA GROUP
ID8B263OtherBCID GROUP