Healthcare Provider Details

I. General information

NPI: 1649845793
Provider Name (Legal Business Name): COREY STURM DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 S APPLE ST
BOISE ID
83706-5150
US

IV. Provider business mailing address

6200 N RIVER POINTE DR APT C204
GARDEN CITY ID
83714-1851
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 Number7474
License Number StateID

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: