| NPI | 1174712418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB BENJAMIN ROBERTS Physical Therapist 208-521-7336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: ID PT-2217) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2021-04-19 |