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FUNCTIONAL PHYSICAL THERAPY CENTER

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Company Details

Name: FUNCTIONAL PHYSICAL THERAPY CENTER
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 11 Dec 2014 (11 years ago)
Entity Number: 531112
Place of Formation: IDAHO
File Number: 0000531112
ZIP code: 83646
County: Ada County
Mailing Address: 4619 W STEEPLECHASE DR MERIDIAN, ID 83646

National Provider Identifier

NPI Number:
1902182298

Authorized Person:

Name:
RAJCOOMAR ISSUREE
Role:
PHYSICAL THERAPIST/DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
261QP2000X - Physical Therapy Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2083767487

Filing

Filing Name Filing Number Filing date
Initial Filing 0000531112 2014-12-11

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State