| NPI | 1538514088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EUGENE C LYONS Owner 208-484-2134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: ID 1156) |
| Additional Taxonomies | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) (Licence: ID 1156) |
| 282N00000X General Acute Care Hospital (Licence: ID 1156) | |
| 302R00000X Health Maintenance Organization (Licence: ID 1156) | |
| 305R00000X Preferred Provider Organization (Licence: ID 1156) | |
| 305S00000X Point of Service (Licence: ID 1156) | |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2016-05-03 |