Healthcare Provider Details

I. General information

NPI: 1457518433
Provider Name (Legal Business Name): CRAIG ESPLIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 S HILTON ST
BOISE ID
83705-1960
US

IV. Provider business mailing address

14497 W KENSINGTON CT
BOISE ID
83713-0975
US

V. Phone/Fax

Practice location:
  • Phone: 208-344-9915
  • Fax:
Mailing address:
  • Phone: 208-938-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-1529
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: