Provider Demographics
NPI:1992932263
Name:STREUBEL THERAPY SERVICES
Entity type:Organization
Organization Name:STREUBEL THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STREUBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-354-1999
Mailing Address - Street 1:1479 TABLE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:DRIGGS
Mailing Address - State:ID
Mailing Address - Zip Code:83422-5292
Mailing Address - Country:US
Mailing Address - Phone:208-354-1999
Mailing Address - Fax:866-875-1249
Practice Address - Street 1:285 E LITTLE AVE
Practice Address - Street 2:
Practice Address - City:DRIGGS
Practice Address - State:ID
Practice Address - Zip Code:83422-5137
Practice Address - Country:US
Practice Address - Phone:208-354-1999
Practice Address - Fax:208-354-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-9372251X0800X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID004405500Medicaid
ID6318920001Medicare NSC
ID004405500Medicaid