Healthcare Provider Details

I. General information

NPI: 1942128137
Provider Name (Legal Business Name): PEREGRINE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5909 W STATE ST
BOISE ID
83703-3039
US

IV. Provider business mailing address

5909 W STATE ST
BOISE ID
83703-3039
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-7700
  • Fax: 208-331-2591
Mailing address:
  • Phone: 208-343-7700
  • Fax: 208-331-2591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRYAN STEDNITZ
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: DPT
Phone: 208-343-7700