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NPI Code Detail

MEDICARE: POCATELLO REHABILITATION PA

MEDICARE: POCATELLO REHABILITATION PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistM5852ID

General Provider Information

NPI Number : 1528143864
Entity Type Code : Organization
Provider Name (Legal Business Name) : POCATELLO REHABILITATION PA
Provider Business Mailing Address
First Line : 500 S 11TH AVE STE 201
Second Line :
City : POCATELLO
State : ID
Zip : 83201-4878
Country : US
Telephone Number : 208-234-1984
Fax Number : 208-234-1987
Provider Business Practice Location Address
First Line : 500 S 11TH AVE STE 201
Second Line :
City : POCATELLO
State : ID
Zip : 83201-4878
Country : US
Telephone Number : 208-234-1984
Fax Number : 208-234-1987
Authorized Official
Title or Position : PRESIDENT
Name : MR. KEVIN S. HILL
Credential : M.D.
Telephone Number : 208-234-1984
Provider Enumeration Date : 10/26/2006
Last Update Date : 08/22/2020

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Directions to “POCATELLO REHABILITATION PA ” Practice Location

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