| NPI | 1447389093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY THOMAS PETTINGER President 208-406-5195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: ID 002818813) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-08-22 |