Basic Information
| Provider Information | |||||||||
| NPI: | 1144334525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERMOUNTAIN PHYSICAL THERAPY LIMITED PARTNERSHIP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 W SAM HOUSTON PKWY S | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770422447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7132977000 | ||||||||
| FaxNumber: | 7132977090 | ||||||||
| Practice Location | |||||||||
| Address1: | 554 STEELHEAD WAY | ||||||||
| Address2: | SUITE 162 | ||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837048391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083239747 | ||||||||
| FaxNumber: | 2083239752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | BINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 7132977000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.