Provider Demographics
NPI:1467666065
Name:MOUNTAIN VIEW PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-290-5575
Mailing Address - Street 1:803 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1828
Mailing Address - Country:US
Mailing Address - Phone:208-290-5575
Mailing Address - Fax:208-255-5830
Practice Address - Street 1:803 PINE ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1828
Practice Address - Country:US
Practice Address - Phone:208-290-5575
Practice Address - Fax:208-255-5830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDTD630OtherBLUE CROSS OF IDAHO
IDTD630OtherBLUE CROSS OF IDAHO