Provider Demographics
NPI:1336721802
Name:BEYOND PHYSICAL THERAPY & PERFORMANCE PLLC
Entity Type:Organization
Organization Name:BEYOND PHYSICAL THERAPY & PERFORMANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:608-558-3657
Mailing Address - Street 1:17415 N FLAGSTAFF WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5495
Mailing Address - Country:US
Mailing Address - Phone:208-995-6671
Mailing Address - Fax:208-473-7313
Practice Address - Street 1:109 13TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3904
Practice Address - Country:US
Practice Address - Phone:208-995-6671
Practice Address - Fax:208-473-7313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty