Provider Demographics
NPI:1134625338
Name:IDAHO FALLS HAND THERAPY LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:IDAHO FALLS HAND THERAPY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-572-9000
Mailing Address - Street 1:5120 WOODWAY DR STE 10001
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1792
Mailing Address - Country:US
Mailing Address - Phone:713-572-9000
Mailing Address - Fax:713-572-9001
Practice Address - Street 1:564 S WOODRUFF AVENUE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-523-7571
Practice Address - Fax:208-523-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy