| Mikaela Virgin, PT | |
|
672 E Wythe Creek Ct, Kuna, ID 83634-5216 | |
| (208) 922-9828 | |
| Not Available |
| Full Name | Mikaela Virgin |
|---|---|
| Gender | Female |
| Speciality | Physical Therapist |
| Location | 672 E Wythe Creek Ct, Kuna, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871210500 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 8477 (Idaho) | Primary |
| Provider Name | Altitude Physical Therapy Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1619045309 PECOS PAC ID: 0244267029 Enrollment ID: O20050722000897 |
| Mailing Address | Practice Location Address |
|---|---|
| Mikaela Virgin, PT 1185 E Trophy St, Kuna, ID 83634-3541 Ph: (503) 577-8901 | Mikaela Virgin, PT 672 E Wythe Creek Ct, Kuna, ID 83634-5216 Ph: (208) 922-9828 |
Derek James Wasden, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 943 N Linder Rd Ste 104, Kuna, ID 83634 Phone: 208-972-4612 Fax: 208-991-1595 | |
Alyssa Parco, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 672 E Wythe Creek Ct Ste 103, Kuna, ID 83634 Phone: 208-922-9828 | |
Andrew Boynton, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 943 N Linder Rd Ste 104, Kuna, ID 83634 Phone: 208-922-1719 Fax: 208-922-1721 | |
Alexis Pettersen, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 672 E Wythe Creek Ct, Kuna, ID 83634 Phone: 208-922-9828 | |
Robert Gray Vining Iii, MPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 943 N Linder Rd, Suite 104, Kuna, ID 83634 Phone: 208-922-1719 Fax: 208-322-8710 | |
Suzanne Baker Stewart, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 333 Avenue C, Suite 3, Kuna, ID 83634 Phone: 208-922-5057 | |
Rocky Wade Elsasser, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 943 N Linder Rd, Suite 104, Kuna, ID 63634 Phone: 208-922-1719 Fax: 208-922-1721 |