| NPI | 1962424952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIFFORD KIRACOFE Owner 208-772-6991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID pt1579) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 1620) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-06-12 |