Basic Information
| Provider Information | |||||||||
| NPI: | 1164850947 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OROFINO PHYSICAL THERAPY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 MICHIGAN AVENUE | ||||||||
| Address2: | |||||||||
| City: | OROFINO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835441005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084769365 | ||||||||
| FaxNumber: | 2084769366 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 MICHIGAN AVENUE | ||||||||
| Address2: | |||||||||
| City: | OROFINO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835442546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083750666 | ||||||||
| FaxNumber: | 2083752996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2013 | ||||||||
| LastUpdateDate: | 03/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | MCCARTHY | ||||||||
| AuthorizedOfficialFirstName: | SHELLIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2083750666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT538 | ID | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.