Provider Demographics
NPI:1528101961
Name:STREHLE, JOHANNA MAE (MPT)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MAE
Last Name:STREHLE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3415
Mailing Address - Country:US
Mailing Address - Phone:208-743-1795
Mailing Address - Fax:208-743-1971
Practice Address - Street 1:1023 21ST ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3415
Practice Address - Country:US
Practice Address - Phone:208-743-1795
Practice Address - Fax:208-743-1971
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009360225100000X
IDPT-1861261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist