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:
Map and Directions
Authorized official contact:
Name: Longoria, Jennifer
Phone: (208) 939-3334

Health care specialties

SpecialtyCodeLicense #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 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194125617 NPPES
Idaho MEDICAID 1194125617
Idaho MEDICAID 1013086610

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