Provider Demographics
NPI:1104879261
Name:STERNKE, ALICE (RPT)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:STERNKE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1886
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83303-1886
Mailing Address - Country:US
Mailing Address - Phone:208-736-0887
Mailing Address - Fax:208-736-0890
Practice Address - Street 1:1785 DANMORE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6606
Practice Address - Country:US
Practice Address - Phone:208-343-1173
Practice Address - Fax:208-736-0890
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010018457OtherREGENCE
IDT0643OtherBLUE CROSS
ID804083800Medicaid