Provider Demographics
NPI:1760263883
Name:MOUNTAIN VIEW PHYSIATRY
Entity Type:Organization
Organization Name:MOUNTAIN VIEW PHYSIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKALEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-777-5511
Mailing Address - Street 1:1869 E SELTICE WAY # 531
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1138 E POLELINE AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6150
Practice Address - Country:US
Practice Address - Phone:208-777-5511
Practice Address - Fax:724-426-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-13
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty