NPI age
19 years
Enumerated 2007-05-21
Across 83 active physical therapist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1008987 | STATE INS VENDOR # |
| 01 (ID) | TA179 | BCBS ID # |
| 01 (ID) | 611699600 | ACS PROVDER # |
| 05 (ID) | 804131400 |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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