Provider Demographics
NPI:1962666164
Name:THAYN, ZHOHNANN KATHLEEN PIVA (PT)
Entity Type:Individual
Prefix:
First Name:ZHOHNANN
Middle Name:KATHLEEN PIVA
Last Name:THAYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ZHOHNANN
Other - Middle Name:KATHLEEN
Other - Last Name:PIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226-0707
Mailing Address - Country:US
Mailing Address - Phone:208-859-9570
Mailing Address - Fax:
Practice Address - Street 1:510 N HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226
Practice Address - Country:US
Practice Address - Phone:208-454-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist