| NPI | 1427029610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY MCCULLY Manager 208-734-5313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID RPT-208) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID RPT-267) |
| 225100000X Physical Therapist (Licence: ID RPT-432) | |
| 225100000X Physical Therapist (Licence: ID PT-2561) | |
| 225100000X Physical Therapist (Licence: ID RPT-1549) | |
| 225100000X Physical Therapist (Licence: ID RPT-1620) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2014-05-09 |