| NPI | 1235789249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHALOAM AGALELEI OFISA Owner 208-242-3723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 225100000X Physical Therapist |
| 111N00000X Chiropractor | |
| 171100000X Acupuncturist | |
| 208D00000X General Practice | |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2019-09-12 |