Provider Demographics
NPI:1134251507
Name:MOUNTAIN HOME PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:MOUNTAIN HOME PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:SESSIONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-587-8944
Mailing Address - Street 1:230 E 5TH N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-2749
Mailing Address - Country:US
Mailing Address - Phone:208-587-8944
Mailing Address - Fax:208-587-6105
Practice Address - Street 1:230 E 5TH N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-2749
Practice Address - Country:US
Practice Address - Phone:208-587-8944
Practice Address - Fax:208-587-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1652756Medicare ID - Type UnspecifiedMEDICARE NUMBER