| NPI | 1174699342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDI SCOTT Owner 208-233-1064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT1078) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2020-08-22 |