Provider Demographics
NPI:1689089971
Name:ROCK AND ARMOR PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:ROCK AND ARMOR PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-917-2660
Mailing Address - Street 1:535 N LOCUST GROVE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9020
Mailing Address - Country:US
Mailing Address - Phone:208-917-2660
Mailing Address - Fax:208-917-2630
Practice Address - Street 1:535 N LOCUST GROVE RD STE 170
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9020
Practice Address - Country:US
Practice Address - Phone:208-917-2660
Practice Address - Fax:208-917-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT2867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty