| NPI | 1215381181 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN ROBERT HIGBEE Owner 208-242-8617 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: ID PT-3095) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2019-10-29 |