HIGHLAND PHYSICAL THERAPY LLC

Provider Demographics

• NPI: 1477625283
• Name: HIGHLAND PHYSICAL THERAPY LLC
• Entity Type: Organization
• Organization Name: HIGHLAND PHYSICAL THERAPY LLC
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: KIMBERLY
• Authorized Official - Last Name: SCHWARZE
• Authorized Official - Credentials: MPT
• Authorized Official - Phone: 208-237-2080
• Mailing Address - Street 1: 1940 S BONITO WAY STE 190
• Mailing Address - City: MERIDIAN
• Mailing Address - State: ID
• Mailing Address - Zip Code: 83642-5618
• Mailing Address - Country: US
• Mailing Address - Phone: 208-287-9420
• Mailing Address - Fax: 208-287-9426
• Practice Address - Street 1: 1951 BENCH RD
• Practice Address - Street 2: SUITE E
• Practice Address - City: POCATELLO
• Practice Address - State: ID
• Practice Address - Zip Code: 83201
• Practice Address - Country: US
• Practice Address - Phone: 208-237-2080
• Practice Address - Fax: 208-237-1084
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-15
• Last Update Date: 2023-02-28

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	174400000X	Other Service Providers	Specialist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
ID	000010155953	Other	DALE WHEELWRIGHT
ID	1356304737	Other	DALE WHEELWRIGHT NPI
ID	1558324590	Other	MICHAEL OTTO NPI
ID	806464000	Medicaid
ID	805478000	Medicaid
ID	TD478	Other	MICHAEL OTTO
ID	TD481	Other	DALE WHEELWRIGHT
ID	000010155854	Other	MICHAEL OTTO
ID	T9325	Other	HIGHLAND PHYSICAL THERAPY
ID	000010155857	Other	JONI VAUGHN POWELL
ID	002682600	Medicaid
ID	1962465344	Other	JONI VAUGHN POWELL NPI
ID	TD480	Other	JONI VAUGHN POWELL
ID	000010155857	Other	JONI VAUGHN POWELL
ID	1368950	Medicare ID - Type Unspecified	MEDICARE GROUP NUMBER
ID	T9325	Other	HIGHLAND PHYSICAL THERAPY
ID	806464000	Medicaid