Provider Demographics
NPI:1205857323
Name:LORI-ANN BLUEMER MPT PA
Entity Type:Organization
Organization Name:LORI-ANN BLUEMER MPT PA
Other - Org Name:ADVANCED REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUEMER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-659-4005
Mailing Address - Street 1:PO BOX 3208
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-3208
Mailing Address - Country:US
Mailing Address - Phone:208-659-4005
Mailing Address - Fax:208-772-0246
Practice Address - Street 1:640 N THORNTON ST
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854
Practice Address - Country:US
Practice Address - Phone:208-659-4005
Practice Address - Fax:208-772-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1767261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1366466Medicare UPIN