Provider Demographics
NPI:1730219361
Name:GEM REHABILITATION SERVICES, INC.
Entity type:Organization
Organization Name:GEM REHABILITATION SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-793-3333
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:ID
Mailing Address - Zip Code:83629-0205
Mailing Address - Country:US
Mailing Address - Phone:208-793-3333
Mailing Address - Fax:208-621-0234
Practice Address - Street 1:400 HIGHWAY 55 STE A
Practice Address - Street 2:SUITE B
Practice Address - City:HORSESHOE BEND
Practice Address - State:ID
Practice Address - Zip Code:83629-9016
Practice Address - Country:US
Practice Address - Phone:208-793-3333
Practice Address - Fax:208-793-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010007267OtherBLUE SHIELD OF IDAHO GROU
ID002636700Medicaid
ID185456700OtherUS DEPT OF LABOR
ID124160OtherWASH. STATE DEPT OF LABOR
ID8B305OtherBLUE CROSS OF IDAHO GROUP
ID185456700OtherUS DEPT OF LABOR