Healthcare Provider Details

I. General information

NPI: 1104879261
Provider Name (Legal Business Name): ALICE STERNKE RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 DANMORE DR
BOISE ID
83712-6606
US

IV. Provider business mailing address

PO BOX 1886
TWIN FALLS ID
83303-1886
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-1173
  • Fax: 208-736-0890
Mailing address:
  • Phone: 208-736-0887
  • Fax: 208-736-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-114
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: