Provider Demographics
NPI:1356491187
Name:IDAHO STATE UNIVERSITY
Entity Type:Organization
Organization Name:IDAHO STATE UNIVERSITY
Other - Org Name:IDAHO STATE UNIVERSITY PHYSICAL AND OCCUPATIONAL THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPARTMENT CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, PHD
Authorized Official - Phone:208-282-4095
Mailing Address - Street 1:921 S 8TH AVE
Mailing Address - Street 2:MAIL STOP 8045
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0001
Mailing Address - Country:US
Mailing Address - Phone:208-282-2590
Mailing Address - Fax:208-282-4962
Practice Address - Street 1:1400 E. TERRY
Practice Address - Street 2:GARRISON BLDG. 63 #202
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-8045
Practice Address - Country:US
Practice Address - Phone:208-282-2590
Practice Address - Fax:208-282-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID225100000X, 2251N0400X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty