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VALLEY VISTA THERAPY SERVICES

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Company Details

Name: VALLEY VISTA THERAPY SERVICES
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 02 Nov 2001 (24 years ago)
Entity Number: 160342
Place of Formation: IDAHO
File Number: 0000160342
ZIP code: 83861
County: Benewah County
Mailing Address: 820 ELM ST ST MARIES, ID 83861

National Provider Identifier

NPI Number:
1073718391

Authorized Person:

Name:
SANDY KENNELLY
Role:
CORPORATE COMPLIANCE MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
2083X0100X - Occupational Medicine Physician
Is Primary:
No
Selected Taxonomy:
2083X0100X - Occupational Medicine Physician
Is Primary:
No
Selected Taxonomy:
235Z00000X - Speech-Language Pathologist
Is Primary:
No
Selected Taxonomy:
261QP2000X - Physical Therapy Clinic/Center
Is Primary:
No

Contacts:

Fax:
2082455909

Filing

Filing Name Filing Number Filing date
Initial Filing 0000160342 2001-11-02

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Date of last update: 23 Sep 2024

Sources: Idaho Secretary of State