| NPI | 1194125617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LONGORIA Office Manager 208-939-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID pt-1450) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: ID ot-928) |
| 235Z00000X Speech-Language Pathologist, (Licence: ID slp-2249) | |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2019-07-09 |