NPI age
20 years
Enumerated 2005-12-21
Across 98 active physical medicine & rehabilitation providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | M7342 | STATE LICENSE |
| 05 (ID) | 1831175819 |
Part of a multi-provider practice. 27 other active providers share this practice address in NPPES.
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