Provider Demographics
NPI:1194510867
Name:PALOUSE PELVIC REHABILITATION & PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:PALOUSE PELVIC REHABILITATION & PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:509-553-9397
Mailing Address - Street 1:1944 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9657
Mailing Address - Country:US
Mailing Address - Phone:509-553-9397
Mailing Address - Fax:
Practice Address - Street 1:1944 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9657
Practice Address - Country:US
Practice Address - Phone:509-553-9397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy