| NPI | 1497711329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY MECHAM Administrator 208-884-1333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-01-15 |