Provider Demographics
NPI:1073853529
Name:THERAPY CONNECTION
Entity Type:Organization
Organization Name:THERAPY CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, LAT
Authorized Official - Phone:208-337-5346
Mailing Address - Street 1:1560 S CAROL ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1839
Mailing Address - Country:US
Mailing Address - Phone:208-288-1155
Mailing Address - Fax:208-288-0424
Practice Address - Street 1:1611 N WHITLEY DR
Practice Address - Street 2:UNIT 1A
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2177
Practice Address - Country:US
Practice Address - Phone:208-452-0021
Practice Address - Fax:208-452-0019
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REHABAUTHORITY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-20
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty