Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Idaho Pediatric Therapy Clinic PLLC

Organization Physical Therapist · NPI 1194125617

Idaho Pediatric Therapy Clinic PLLC is a Physical Therapist in Meridian, Idaho. Licensed in Idaho. Registered with an NPI since 2014.

Licensed in
ID
In the registry since
2014
Specialties on file
3
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3080 E Gentry Way Ste 180
Meridian, ID 83642-3544
Phone: (208) 939-3334
Fax: (208) 939-1122
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT-1450 (ID)
Occupational Therapist Taxonomy 225X00000X · Licence OT-928 (ID)
Speech-Language Pathologist Taxonomy 235Z00000X · Licence SLP-2249 (ID)

Record details

NPI number1194125617
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Longoria — Office Manager · (208) 939-3334
NPI enumeratedSeptember 3, 2014
Last updated in NPPESJuly 9, 2019
Mailing address3080 E Gentry Way Ste 180, Meridian, ID 83642-3544

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