| NPI | 1821502204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTIAN VANDERFORD Owner/Physical Therapist 208-255-8364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2378) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2023-07-10 |