Basic Information
| Provider Information | |||||||||
| NPI: | 1356503841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRATT | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1590 E POLSTON AVE | ||||||||
| Address2: | SUITE #B | ||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838545218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087774242 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1590 E POLSTON AVE | ||||||||
| Address2: | SUITE #B | ||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838545218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087774242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 12/19/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60013048 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT-2479 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.