Healthcare Provider Details

I. General information

NPI: 1033894936
Provider Name (Legal Business Name): DANIEL CAMARGO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD STE 204
BOISE ID
83706-1340
US

IV. Provider business mailing address

1905 CAMBRIDGE ST
CALDWELL ID
83607-8143
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-3315
  • Fax:
Mailing address:
  • Phone: 208-982-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-8802
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: