Provider Demographics
NPI:1366198376
Name:ON THE GO PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:ON THE GO PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINSEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TROUT CAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-540-1990
Mailing Address - Street 1:14962 N WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8435
Mailing Address - Country:US
Mailing Address - Phone:208-540-1990
Mailing Address - Fax:
Practice Address - Street 1:14962 N WRIGHT ST
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-8435
Practice Address - Country:US
Practice Address - Phone:208-540-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty