Middleton Physical Therapy, LLC
Organization Active NPI Physical Therapist · Middleton, ID
NPI 1477190858 · NPPES record last updated Mar 17, 2020
Key facts
- NPI
- 1477190858
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- MIDDLETON PHYSICAL THERAPY, LLC
- Practice address
- 1020 W Main St
Middleton, ID 83644-5270 - Phone
- (208) 585-3932
- Fax
- (208) 565-2218
- NPI assigned
- Dec 5, 2019
- Organization subpart
- No
Authorized official
- Name
- Marc Patten Grow, MPT
- Title
- Owner/Physical Therapist
- Phone
- (208) 850-8295
Practitioners 2
-
Marc Grow, MPT
-
Cary Lynn Hubert, RPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200421003258 | ID | Part B Supplier - Clinic/Group Practice | 9436589074 |
Receives reassigned benefits from 1 practitioner Practice locations: Middleton, ID |
National Provider Directory
Locations
1020 W Main St
Middleton, ID 83644
Phone (208) 585-3932
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
1020 W Main St
Middleton, ID 83644-5270
Mailing address
1020 W Main St
Middleton, ID 83644-5270
Other providers in Middleton, ID
- Tammy M Marr
- Alma Martinez
- Abbey L. Mayes
- Jasmine E Melendez
- Middleton Chiropractic LLC
- Middleton School District
- Middleton Upper Cervical Chiropractic PLLC
- Holly Kathleen Miller
- Kristin Nicole Silva Miller
- Suzanne Elise Monaghan
All providers in Middleton, ID · Physical Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.