Provider Demographics
NPI:1194535682
Name:ORTHOPRO OF TWIN FALLS, INC.
Entity type:Organization
Organization Name:ORTHOPRO OF TWIN FALLS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-733-0505
Mailing Address - Street 1:1437 PARK VIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3250
Mailing Address - Country:US
Mailing Address - Phone:208-733-0505
Mailing Address - Fax:208-734-0766
Practice Address - Street 1:3438 S 15TH E STE 100
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8262
Practice Address - Country:US
Practice Address - Phone:208-878-0501
Practice Address - Fax:208-734-0766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPRO OF TWIN FALLS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier