Provider Demographics
NPI:1881226652
Name:STRIDER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STRIDER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORATE PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STERLING
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-368-7519
Mailing Address - Street 1:3155 CHANNING WAY STE A
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7875
Mailing Address - Country:US
Mailing Address - Phone:208-522-6044
Mailing Address - Fax:
Practice Address - Street 1:3155 CHANNING WAY STE A
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7875
Practice Address - Country:US
Practice Address - Phone:208-522-6044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy