Provider Demographics
NPI: | 1821661927 |
---|---|
Name: | CURRENT PHYSICAL THERAPY KUNA LLC |
Entity Type: | Organization |
Organization Name: | CURRENT PHYSICAL THERAPY KUNA LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/PROVIDER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NICHOLAS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HARTLEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPT |
Authorized Official - Phone: | 541-212-0037 |
Mailing Address - Street 1: | 943 N LINDER RD STE 104 |
Mailing Address - Street 2: | |
Mailing Address - City: | KUNA |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83634-3395 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-972-4612 |
Mailing Address - Fax: | 208-991-1595 |
Practice Address - Street 1: | 943 N LINDER RD STE 104 |
Practice Address - Street 2: | |
Practice Address - City: | KUNA |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83634-3395 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-800-1619 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-07-19 |
Last Update Date: | 2022-01-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Single Specialty |