Provider Demographics
NPI:1821502204
Name:ACTION POINT PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ACTION POINT PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-255-8364
Mailing Address - Street 1:PO BOX 2490
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0915
Mailing Address - Country:US
Mailing Address - Phone:208-284-3597
Mailing Address - Fax:208-718-6341
Practice Address - Street 1:606 N FIFTH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1520
Practice Address - Country:US
Practice Address - Phone:208-284-3597
Practice Address - Fax:208-718-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2378225100000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1770747404Medicaid