Provider Demographics
NPI:1023028818
Name:PATRICIA HYATT PT LLC
Entity type:Organization
Organization Name:PATRICIA HYATT PT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-879-6671
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:CHALLIS
Mailing Address - State:ID
Mailing Address - Zip Code:83226-1395
Mailing Address - Country:US
Mailing Address - Phone:208-879-6671
Mailing Address - Fax:208-879-6680
Practice Address - Street 1:1050 CLINIC RD N
Practice Address - Street 2:
Practice Address - City:CHALLIS
Practice Address - State:ID
Practice Address - Zip Code:83226-9376
Practice Address - Country:US
Practice Address - Phone:208-879-6671
Practice Address - Fax:208-879-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2010261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy