| Proactive Physical Therapy Pc | |
|
2311 Park Ave, Suite 2, Burley, ID 83318-2170 | |
| (208) 677-2489 | |
| (208) 677-4023 |
| Full Name | Proactive Physical Therapy Pc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 2311 Park Ave, Burley, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609093434 | NPI | - | NPPES |
| 805407300 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT1299 (Idaho) | Primary |
| Provider Name | Raulan Young |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1700954161 PECOS PAC ID: 0547449217 Enrollment ID: I20110126001180 |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Physical Therapy Pc 2311 Park Ave, Suite 2, Burley, ID 83318-2170 Ph: (208) 677-2489 | Proactive Physical Therapy Pc 2311 Park Ave, Suite 2, Burley, ID 83318-2170 Ph: (208) 677-2489 |
Dr. Tyler Carlen, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1501 Hiland Ave, Burley, ID 83318 Phone: 208-677-6530 | |
Nicholas Lewis, PT, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1945 Hiland Ave, Burley, ID 83318 Phone: 208-647-0024 Fax: 208-647-0239 | |
Austin Stoddard, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1263 Bennett Ave Ste 2, Burley, ID 83318 Phone: 208-678-1191 | |
Mr. Jeffrey Dwain Manion, MPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 933 Sandy Glen Ln, Burley, ID 83318 Phone: 402-290-4584 | |
Ryan Patrick Mccormick, P.T., D.P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1945 Hiland Ave, Burley, ID 83318 Phone: 208-647-0024 Fax: 208-647-0239 | |
Troy Michael Anderson, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1501 Hiland Ave, Burley, ID 83318 Phone: 208-677-6530 | |
Antonino Roberto Russo, Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1945 Hiland Ave, Burley, ID 83318 Phone: 208-647-0024 |