Healthcare Provider Details

I. General information

NPI: 1639365323
Provider Name (Legal Business Name): ZRJ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 12/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12072 MCMILLAN RD
BOISE ID
83713-2462
US

IV. Provider business mailing address

12072 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 TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number928
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1455
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1208
License Number StateID

VIII. Authorized Official

Name: MR. ROBERT BRET ADAMS
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: PT
Phone: 208-939-0533