Provider Demographics
NPI:1104672682
Name:PRIMARY THERAPY SOURCE LLC
Entity type:Organization
Organization Name:PRIMARY THERAPY SOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:YINGST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-734-7333
Mailing Address - Street 1:254 RIVER VISTA PL
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3006
Mailing Address - Country:US
Mailing Address - Phone:208-734-7333
Mailing Address - Fax:208-734-8350
Practice Address - Street 1:254 RIVER VISTA PL
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3006
Practice Address - Country:US
Practice Address - Phone:208-734-7333
Practice Address - Fax:208-734-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment