NPI age
19 years
Enumerated 2006-11-05
Across 98 active physical medicine & rehabilitation providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (MT) | 0151424 | MDCD PIN |
| 01 (MT) | 000092646 | BCBS PIN |
| 01 (WY) | 122153100 | MDCD PIN |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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