Provider Demographics
NPI:1083809008
Name:PURE INC
Entity Type:Organization
Organization Name:PURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:FALETTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-691-8888
Mailing Address - Street 1:3655 N GOVERNMENT WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8332
Mailing Address - Country:US
Mailing Address - Phone:208-691-8888
Mailing Address - Fax:
Practice Address - Street 1:3655 N GOVERNMENT WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8332
Practice Address - Country:US
Practice Address - Phone:208-691-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPT1746OtherSTATE LISCENSE