| NPI | 1104226828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN ROY GARDUNIA Owner/President 208-351-9955 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: ID PT2549) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2014-11-20 |