Provider Demographics
NPI:1477573756
Name:TRI-CITY PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:TRI-CITY PHYSICAL THERAPY, P.C.
Other - Org Name:ADVANCED PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-452-6366
Mailing Address - Street 1:275 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-2303
Mailing Address - Country:US
Mailing Address - Phone:208-549-1008
Mailing Address - Fax:208-549-1396
Practice Address - Street 1:275 E 7TH ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672-2303
Practice Address - Country:US
Practice Address - Phone:208-549-1008
Practice Address - Fax:208-549-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID804093200Medicaid
ID1652283Medicare PIN
1652283Medicare UPIN