Provider Demographics
NPI:1598222770
Name:PT WORKS INC
Entity Type:Organization
Organization Name:PT WORKS INC
Other - Org Name:STAR PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MPT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-251-6301
Mailing Address - Street 1:316 W 2ND S
Mailing Address - Street 2:
Mailing Address - City:SODA SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83276-1515
Mailing Address - Country:US
Mailing Address - Phone:208-251-6301
Mailing Address - Fax:
Practice Address - Street 1:316 W 2ND S
Practice Address - Street 2:
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276-1515
Practice Address - Country:US
Practice Address - Phone:208-251-6301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty