Provider Demographics
NPI:1447389093
Name:PREFERRED PHYSICAL THERAPY, P.A.
Entity Type:Organization
Organization Name:PREFERRED PHYSICAL THERAPY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-406-5195
Mailing Address - Street 1:126 E MAIN ST
Mailing Address - Street 2:PO BOX 327
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-2211
Mailing Address - Country:US
Mailing Address - Phone:208-406-5195
Mailing Address - Fax:208-983-0114
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-2211
Practice Address - Country:US
Practice Address - Phone:208-406-5195
Practice Address - Fax:208-983-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy