Healthcare Provider Details

I. General information

NPI: 1770159972
Provider Name (Legal Business Name): NICOLE BISCHEL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2021
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12072 W MCMILLAN RD
BOISE ID
83713-2462
US

IV. Provider business mailing address

12072 W MCMILLAN RD
BOISE ID
83713-2462
US

V. Phone/Fax

Practice location:
  • Phone: 208-939-0533
  • Fax: 208-939-3341
Mailing address:
  • Phone: 208-939-0533
  • Fax: 208-939-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-7510
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: