Provider Demographics
NPI:1497143507
Name:PRECISION PERFORMANCE AND THERAPY
Entity Type:Organization
Organization Name:PRECISION PERFORMANCE AND THERAPY
Other - Org Name:FUNCTIONAL PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-760-9988
Mailing Address - Street 1:4619 W STEEPLECHASE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6495
Mailing Address - Country:US
Mailing Address - Phone:208-760-9988
Mailing Address - Fax:
Practice Address - Street 1:8950 W EMERALD ST
Practice Address - Street 2:STE 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4854
Practice Address - Country:US
Practice Address - Phone:208-376-7313
Practice Address - Fax:208-376-7487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-28322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty