NPI | 1093253940 |
---|---|
Doing Business As | LAKE COUNTRY PHYSICAL THERAPY |
Entity Type | Organization |
Authorized Contact | SHAWNA E BENNER-ERICKSON Owner/Physical Therapist 208-263-1632 |
Organization Subpart ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1783) |
Enumeration Date | 2017-02-10 |
Last Update Date | 2017-02-10 |