Provider Demographics
NPI:1053668970
Name:THAYN PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:THAYN PHYSICAL THERAPY, PLLC
Other - Org Name:THAYN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ZHOHNANN
Authorized Official - Middle Name:KATHLEEN PIVA
Authorized Official - Last Name:THAYN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-859-9570
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226-0707
Mailing Address - Country:US
Mailing Address - Phone:208-859-9570
Mailing Address - Fax:
Practice Address - Street 1:510 NORTH HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226
Practice Address - Country:US
Practice Address - Phone:208-859-9570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT 2402225100000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty