| NPI | 1417780222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MORGAN JESSE RICKS Owner/Partner 208-715-8504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2025-01-24 |