Provider Demographics
NPI:1417653486
Name:BUILT PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BUILT PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:STRAIT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-220-9195
Mailing Address - Street 1:28 E 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:ID
Mailing Address - Zip Code:83234-1695
Mailing Address - Country:US
Mailing Address - Phone:208-705-4668
Mailing Address - Fax:
Practice Address - Street 1:300 N 5TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6204
Practice Address - Country:US
Practice Address - Phone:208-705-4668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy