| NPI | 1245653468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T BATES Owner 208-904-1112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2025-02-03 |