| NPI | 1083439723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACH HEYREND Administrator 208-495-5202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2025-04-08 |