Basic Information
| Provider Information | |||||||||
| NPI: | 1073853529 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPY CONNECTION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1560 S CAROL ST | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836461839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082881155 | ||||||||
| FaxNumber: | 2082880424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1611 N WHITLEY DR | ||||||||
| Address2: | UNIT 1A | ||||||||
| City: | FRUITLAND | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836192177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084520021 | ||||||||
| FaxNumber: | 2084520019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2013 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2083375346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | REHABAUTHORITY LLC | ||||||||
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| AuthorizedOfficialCredential: | PT, LAT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-178 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.