Provider Demographics
NPI:1730104225
Name:COEUR D'ALENE TRIBE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:COEUR D'ALENE TRIBE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PATIENT FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROWLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-686-1931
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:PLUMMER
Mailing Address - State:ID
Mailing Address - Zip Code:83851
Mailing Address - Country:US
Mailing Address - Phone:208-686-1931
Mailing Address - Fax:208-686-9061
Practice Address - Street 1:110 A STREET
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851
Practice Address - Country:US
Practice Address - Phone:208-686-1931
Practice Address - Fax:208-686-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy