Provider Demographics
NPI:1588333256
Name:IDAHO PHYSICAL REHABILITATION LLC
Entity type:Organization
Organization Name:IDAHO PHYSICAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-794-6869
Mailing Address - Street 1:100 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-4401
Mailing Address - Country:US
Mailing Address - Phone:800-588-2539
Mailing Address - Fax:208-329-5807
Practice Address - Street 1:300 STIBNITE AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-4407
Practice Address - Country:US
Practice Address - Phone:800-588-2539
Practice Address - Fax:208-329-5807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty