Provider Demographics
NPI:1164850947
Name:OROFINO PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:OROFINO PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-0666
Mailing Address - Street 1:1005 MICHIGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1005
Mailing Address - Country:US
Mailing Address - Phone:208-476-9365
Mailing Address - Fax:208-476-9366
Practice Address - Street 1:1005 MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-2546
Practice Address - Country:US
Practice Address - Phone:208-375-0666
Practice Address - Fax:208-375-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty