NPI age
19 years
Enumerated 2007-04-17
Across 2006 active physical therapist providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 1346465887 | |
| 05 (UT) | D5960 | |
| 01 (ID) | PT-2026 | PHYSICAL THERAPY LICENSE |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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