Provider Demographics
NPI:1346876166
Name:TIMBER RIDGE INDUSTRIAL THERAPY, PLLC
Entity Type:Organization
Organization Name:TIMBER RIDGE INDUSTRIAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:STODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OTR/L
Authorized Official - Phone:208-818-7404
Mailing Address - Street 1:31200 N RED FIR RD
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:ID
Mailing Address - Zip Code:83801-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:208-567-9508
Practice Address - Street 1:610 HUBBARD AVE STE 226
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-818-7404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy