Provider Demographics
NPI:1629288923
Name:CANYON HAND THERAPY INC.
Entity Type:Organization
Organization Name:CANYON HAND THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL CLT
Authorized Official - Phone:208-539-2784
Mailing Address - Street 1:1897 ALTURAS DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4906
Mailing Address - Country:US
Mailing Address - Phone:208-539-2784
Mailing Address - Fax:208-733-1852
Practice Address - Street 1:1897 ALTURAS DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4906
Practice Address - Country:US
Practice Address - Phone:208-539-2784
Practice Address - Fax:208-733-1852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOT618225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty