| NPI | 1205495371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN HATCH Owner 208-538-3122 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional |
| Additional Taxonomies | 174H00000X Health Educator |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |