Provider Demographics
NPI:1336102318
Name:DM MANAGEMENT PC
Entity Type:Organization
Organization Name:DM MANAGEMENT PC
Other - Org Name:ONE ON ONE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-888-4321
Mailing Address - Street 1:2321 E GALA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4881
Mailing Address - Country:US
Mailing Address - Phone:208-888-4321
Mailing Address - Fax:208-895-8747
Practice Address - Street 1:2321 E GALA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4881
Practice Address - Country:US
Practice Address - Phone:208-888-4321
Practice Address - Fax:208-895-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDTA922OtherBLUE CROSS OF IDAHO GROUP
IDTA922OtherBLUE CROSS OF IDAHO GROUP