Provider Demographics
NPI:1710226220
Name:IDAHO HAND & UPPER EXTREMITY THERAPY DME
Entity type:Organization
Organization Name:IDAHO HAND & UPPER EXTREMITY THERAPY DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:208-664-0575
Mailing Address - Street 1:920 W IRONWOOD DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2463
Mailing Address - Country:US
Mailing Address - Phone:208-664-0575
Mailing Address - Fax:208-664-0576
Practice Address - Street 1:920 W IRONWOOD DR
Practice Address - Street 2:SUITE 207
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2463
Practice Address - Country:US
Practice Address - Phone:208-664-0575
Practice Address - Fax:208-664-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies