| NPI | 1427072982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LANCE MARSHALL Owner 208-232-6490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1535) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT1003) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2017-01-30 |