Provider Demographics
NPI:1972224103
Name:ANEW DAY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:ANEW DAY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHALOAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OFISA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, ACC
Authorized Official - Phone:208-221-2973
Mailing Address - Street 1:750 W QUINN RD STE A
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1929
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 W QUINN RD STE A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202-1929
Practice Address - Country:US
Practice Address - Phone:208-221-2973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy