| NPI | 1538763370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN STODDARD Owner 208-403-7422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2020-11-23 |