Provider Demographics
NPI:1437744752
Name:SCOTT RANDKLEV PHYSICAL THERAPY P.A.
Entity Type:Organization
Organization Name:SCOTT RANDKLEV PHYSICAL THERAPY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDKLEV
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-431-0268
Mailing Address - Street 1:1296 S FAIRMONT LOOP
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-8932
Mailing Address - Country:US
Mailing Address - Phone:208-431-0268
Mailing Address - Fax:
Practice Address - Street 1:370 E KATHLEEN AVE STE 500
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5238
Practice Address - Country:US
Practice Address - Phone:208-292-1372
Practice Address - Fax:208-292-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty