| NPI | 1972011443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN SHATTO Owner 208-870-3350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1883) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2018-03-21 |