| NPI | 1356759781 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES A WHITAKER Owner 208-322-5922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID O-0794) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: ID O-0794) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2016-04-12 |