Idaho Pediatric Therapy Clinic Pllc
LBN: Idaho Pediatric Therapy Clinic Pllc
Idaho Pediatric Therapy Clinic Pllc is an health care organization with primary practice located at 3080 E Gentry Way Ste 180 , Meridian ID 83642-3544. The organization recently has 3 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, Speech, Language and Hearing Service Providers / Speech-Language Pathologist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist is the primary health care specialty.
Idaho Pediatric Therapy Clinic Pllc can be contacted via phone (208) 939-3334, or through Longoria, Jennifer via phone (208) 939-3334.
Contact Information
Primary practice address
3080 E Gentry Way Ste 180
Meridian ID 83642-3544
Phone: (208) 939-3334
Fax: (208) 939-1122
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | PT-1450 | Idaho |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | OT-928 | Idaho |
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | SLP-2249 | Idaho |
Profile Details
| NPI number | 1194125617 |
|---|---|
| LBN Legal business name | Idaho Pediatric Therapy Clinic Pllc |
| DBA Doing business as | |
| Authorized official | Longoria, Jennifer |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 3rd, 2014 |
| Last updated | Jul 9th, 2019 - about 7 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194125617 | NPPES |
| Idaho | MEDICAID | 1194125617 | |
| Idaho | MEDICAID | 1013086610 |
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