Provider Demographics
NPI:1568587707
Name:THERAPY EXPRESS PA
Entity Type:Organization
Organization Name:THERAPY EXPRESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-867-0116
Mailing Address - Street 1:3163 N ASH PARK LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5715
Mailing Address - Country:US
Mailing Address - Phone:208-867-0116
Mailing Address - Fax:
Practice Address - Street 1:8024 W SCARDALE CT
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0713
Practice Address - Country:US
Practice Address - Phone:208-867-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT337261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center