Healthcare Provider Details

I. General information

NPI: 1083473383
Provider Name (Legal Business Name): BEYOND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N CURTIS RD
BOISE ID
83706-1445
US

IV. Provider business mailing address

PO BOX 777447
HENDERSON NV
89077-7447
US

V. Phone/Fax

Practice location:
  • Phone: 833-759-8720
  • Fax: 833-428-7419
Mailing address:
  • Phone: 833-759-8720
  • Fax: 833-428-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LISA ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 833-759-8720