Provider Demographics
NPI:1235526757
Name:PARMA PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:PARMA PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:P
Authorized Official - Last Name:GROW
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-722-7350
Mailing Address - Street 1:P.O. BOX 171
Mailing Address - Street 2:206 N 3RD STREET
Mailing Address - City:PARMA
Mailing Address - State:ID
Mailing Address - Zip Code:83660
Mailing Address - Country:US
Mailing Address - Phone:208-722-7350
Mailing Address - Fax:208-722-7351
Practice Address - Street 1:206 N. 3RD STREET
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:ID
Practice Address - Zip Code:83660-0171
Practice Address - Country:US
Practice Address - Phone:208-850-8295
Practice Address - Fax:208-585-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT2800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1652914Medicare PIN