Provider Demographics
NPI:1346531969
Name:CANFIELD PHYSICAL THERAPY
Entity Type:Organization
Organization Name:CANFIELD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORI-ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUEMER-TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-659-0750
Mailing Address - Street 1:PO BOX 3138
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-3138
Mailing Address - Country:US
Mailing Address - Phone:208-659-0750
Mailing Address - Fax:208-772-0246
Practice Address - Street 1:402 W CANFIELD AVE
Practice Address - Street 2:STE 5
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7784
Practice Address - Country:US
Practice Address - Phone:208-659-0750
Practice Address - Fax:208-772-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-30
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty