| NPI | 1437744752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT RANDKLEV President 208-431-0268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-03-08 |