Healthcare Provider Details

I. General information

NPI: 1245067396
Provider Name (Legal Business Name): JOHN SILER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E PINE ST
CALDWELL ID
83605-4836
US

IV. Provider business mailing address

555 E 12TH ST TRLR 2
WEISER ID
83672-2473
US

V. Phone/Fax

Practice location:
  • Phone: 208-454-5142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-8603
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: