| NPI | 1477093334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAKER RAVEE MEDAVARAPU Physical Therapist 208-816-8836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: ID PT-1243) |
| Enumeration Date | 2017-02-26 |
| Last Update Date | 2023-11-29 |