Provider Demographics
NPI:1679520191
Name:ACTION THERAPY, P.C.
Entity Type:Organization
Organization Name:ACTION THERAPY, P.C.
Other - Org Name:PHYSICAL THERAPY OF IDAHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-888-0044
Mailing Address - Street 1:3090 GENTRY WAY
Mailing Address - Street 2:#250
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-888-0044
Mailing Address - Fax:208-888-2211
Practice Address - Street 1:3090 GENTRY WAY
Practice Address - Street 2:#250
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-888-0044
Practice Address - Fax:208-888-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806486200Medicaid
ID1654137Medicare UPIN