Provider Demographics
NPI:1831972561
Name:PICK PT AMMON LLC
Entity type:Organization
Organization Name:PICK PT AMMON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNSAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:208-534-7001
Mailing Address - Street 1:3155 CHANNING WAY STE B
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7875
Mailing Address - Country:US
Mailing Address - Phone:208-973-4170
Mailing Address - Fax:208-973-4171
Practice Address - Street 1:3155 CHANNING WAY STE B
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7875
Practice Address - Country:US
Practice Address - Phone:208-973-4170
Practice Address - Fax:208-973-4171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PICK PT PHYSICAL THERAPY IDAHO FALLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy