Basic Information
| Provider Information | |||||||||
| NPI: | 1235526757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARMA PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 171 | ||||||||
| Address2: | 206 N 3RD STREET | ||||||||
| City: | PARMA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087227350 | ||||||||
| FaxNumber: | 2087227351 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 N. 3RD STREET | ||||||||
| Address2: | |||||||||
| City: | PARMA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836600171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088508295 | ||||||||
| FaxNumber: | 2085856768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| AuthorizedOfficialLastName: | GROW | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2087227350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT2800 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.