| NPI | 1629146857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK NORTHRUP Owner President 208-221-6952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1280) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-12 |