Healthcare Provider Details

I. General information

NPI: 1578482071
Provider Name (Legal Business Name): JAIDEN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 S APPLE ST
BOISE ID
83706-5150
US

IV. Provider business mailing address

476 E HERON PARK ST
GARDEN CITY ID
83714-5221
US

V. Phone/Fax

Practice location:
  • Phone: 208-385-3400
  • 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: