Healthcare Provider Details

I. General information

NPI: 1235065996
Provider Name (Legal Business Name): AUSTINN ROSSETTI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 W SHORELINE DR STE 230
BOISE ID
83702-6752
US

IV. Provider business mailing address

1619 S PACIFIC ST
BOISE ID
83705-2974
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: