| NPI | 1720402431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE L LARSEN Owner/Physical Therapist 208-816-4195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: ID PT2265) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: WA PT000010795) |
| Enumeration Date | 2014-02-17 |
| Last Update Date | 2014-04-12 |