| NPI | 1215622071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE JOHNSON Treasurer 208-401-1369 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-04-07 |