Provider Demographics
NPI:1710960463
Name:CDA HAND THERAPY & HEALING CENTER PA
Entity Type:Organization
Organization Name:CDA HAND THERAPY & HEALING CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-664-2901
Mailing Address - Street 1:2448 MERRITT CREEK LOOP
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4953
Mailing Address - Country:US
Mailing Address - Phone:208-664-2901
Mailing Address - Fax:208-667-9266
Practice Address - Street 1:2448 MERRITT CREEK LOOP
Practice Address - Street 2:SUITE 2A
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4953
Practice Address - Country:US
Practice Address - Phone:208-664-2901
Practice Address - Fax:208-667-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5003984OtherREGENCE MED ADVANTAGE
DA3588OtherRAILROAD MEDICARE
100000120993OtherREGENCE
185598800OtherFEDERAL L&I
TID 91051 NPIOtherGROUP HEALTH
QMXPR0060660OtherMOLINA
IDM0026441 171096043Medicaid
000010026877OtherREGENCE
0063788OtherWA L&I
IDT9784OtherBLUE CROSS OF IDAHO
TID NPI SSNOtherFIRST CHOICE
IDM0026441 171096043Medicaid
1375239Medicare PIN