Provider Demographics
NPI:1790990570
Name:INTERMOUNTAIN PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:INTERMOUNTAIN PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAWRANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-297-7000
Mailing Address - Street 1:50 E JAMES COURT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 E JAMES COURT DR
Practice Address - Street 2:SUITE A
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8750
Practice Address - Country:US
Practice Address - Phone:208-895-0715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERMOUNTAIN PHYSICAL THERAPY LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-14
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1294120004Medicare NSC