Provider Demographics
NPI:1154481455
Name:AT HOME PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:AT HOME PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-661-6366
Mailing Address - Street 1:1459 W YAQUINA DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5190
Mailing Address - Country:US
Mailing Address - Phone:208-661-6366
Mailing Address - Fax:208-773-5653
Practice Address - Street 1:1459 W YAQUINA DR
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5190
Practice Address - Country:US
Practice Address - Phone:208-661-6366
Practice Address - Fax:208-773-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty