Basic Information
| Provider Information | |||||||||
| NPI: | 1265941108 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSPIRE PHYSICAL THERAPY IDAHO INC PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 DENNIS ST SW STE B | ||||||||
| Address2: | |||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985016523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086657055 | ||||||||
| FaxNumber: | 2086657093 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 N NORTHWOOD CENTER CT STE B | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838144944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086657055 | ||||||||
| FaxNumber: | 2086657093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SIPE | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3609510754 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPT, DPT, SCS | ||||||||
| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.