| NPI | 1760263883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NEILLY BUCKALEW Physician/Co Owner 208-777-5511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2023-12-18 |