| NPI | 1225676372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE DUSBABEK Owner/Physical Therapist 208-755-6945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2019-12-19 |