Healthcare Provider Details

I. General information

NPI: 1235458654
Provider Name (Legal Business Name): TREASURE VALLEY REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 CLEVELAND BLVD STE 110
CALDWELL ID
83605-4079
US

IV. Provider business mailing address

524 E CLEVELAND BLVD STE 110
CALDWELL ID
83605
US

V. Phone/Fax

Practice location:
  • Phone: 208-695-6688
  • Fax:
Mailing address:
  • Phone: 208-695-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-2172
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-810
License Number StateID

VIII. Authorized Official

Name: BOYD S RICKS
Title or Position: OWNER, THERAPIST
Credential: OTR/L, DPT
Phone: 208-695-6688