Provider Demographics
NPI:1851457675
Name:FOOTHILLS PHYSICAL THERAPY PA
Entity Type:Organization
Organization Name:FOOTHILLS PHYSICAL THERAPY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRATARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BROOKS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-343-4700
Mailing Address - Street 1:1673 W SHORELINE DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6730
Mailing Address - Country:US
Mailing Address - Phone:208-343-4700
Mailing Address - Fax:208-343-4706
Practice Address - Street 1:1618 MILLENIUM WAY
Practice Address - Street 2:SUITE 210
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6439
Practice Address - Country:US
Practice Address - Phone:208-884-4647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806761700Medicaid
ID1375990Medicare PIN