Basic Information
| Provider Information | |||||||||
| NPI: | 1982085262 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEAKS TO PLAINS THERAPY SERVICES, PA | ||||||||
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| OtherOrganizationName: | PEAKS TO PLAINS THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 FOUNDERS POINTE DR | ||||||||
| Address2: | |||||||||
| City: | AMMON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834065092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085890807 | ||||||||
| FaxNumber: | 2085429577 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | DRIGGS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834225445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085890807 | ||||||||
| FaxNumber: | 2085429577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2015 | ||||||||
| LastUpdateDate: | 06/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | OLSON | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | LANE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2085899578 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 2251P0200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225200000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 235Z00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 225XP0200X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.