Provider Demographics
NPI:1053857730
Name:ASPIRE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ASPIRE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:GOULD
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-720-3421
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-0092
Mailing Address - Country:US
Mailing Address - Phone:208-720-3421
Mailing Address - Fax:208-297-2680
Practice Address - Street 1:113 E BULLION ST
Practice Address - Street 2:SUITE C
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8770
Practice Address - Country:US
Practice Address - Phone:208-720-3421
Practice Address - Fax:208-297-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
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
IDT4868OtherBLUE CROSS
ID000010030447OtherBLUE SHIELD
ID1275512246Medicaid
ID20002784Medicare PIN