| NPI | 1427375724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE LIDDLE Owner/Manager 208-521-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-954) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: ID DME14657) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2023-03-14 |