| NPI | 1831181106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN B MARTIN Owner 208-232-2740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID rpt004) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID rpt195) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2020-08-22 |