Provider Demographics
NPI:1528143450
Name:ALPINE PHYSICAL THERAPY CENTER, P.C.
Entity type:Organization
Organization Name:ALPINE PHYSICAL THERAPY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-762-0881
Mailing Address - Street 1:PO BOX 3115
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-3115
Mailing Address - Country:US
Mailing Address - Phone:208-762-0881
Mailing Address - Fax:208-762-5961
Practice Address - Street 1:31911 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869
Practice Address - Country:US
Practice Address - Phone:208-623-6717
Practice Address - Fax:208-623-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty