| NPI | 1619316460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY MARIE BERG Owner 208-830-1668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: ID PT-2717) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2014-06-04 |