Healthcare Provider Details

I. General information

NPI: 1710916473
Provider Name (Legal Business Name): ALICE STERNKE & ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 04/05/2013
Certification Date:
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: 208-343-1049
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: ALICE STERNKE
Title or Position: OWNER
Credential: RPT
Phone: 208-343-1173