| NPI | 1851051718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ANNELAINE VANDYKE Owner 208-233-2248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2025-10-15 |