Provider Demographics
NPI:1366698003
Name:CARIBOU PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:CARIBOU PHYSICAL THERAPY P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-265-8333
Mailing Address - Street 1:22 ROUNDHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-8674
Mailing Address - Country:US
Mailing Address - Phone:208-265-8333
Mailing Address - Fax:208-263-1394
Practice Address - Street 1:47390 HIGHWAY 200
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:ID
Practice Address - Zip Code:83836-9647
Practice Address - Country:US
Practice Address - Phone:208-265-8333
Practice Address - Fax:208-263-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010023365OtherBLUE SHIELD
TD780OtherBLUE CROSS
ID804274300Medicaid
ID12083282OtherCAQH