Provider Demographics
NPI:1790380822
Name:HOMETOWN PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:HOMETOWN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-390-1793
Mailing Address - Street 1:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:RIRIE
Mailing Address - State:ID
Mailing Address - Zip Code:83443-0273
Mailing Address - Country:US
Mailing Address - Phone:208-900-6336
Mailing Address - Fax:208-900-4408
Practice Address - Street 1:245 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIRIE
Practice Address - State:ID
Practice Address - Zip Code:83443
Practice Address - Country:US
Practice Address - Phone:208-390-1793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty