Healthcare Provider Details

I. General information

NPI: 1710203344
Provider Name (Legal Business Name): DEBBIE HABIG PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 E RIVERSIDE DR STE 124
EAGLE ID
83616-6824
US

IV. Provider business mailing address

323 E RIVERSIDE DR
EAGLE ID
83616-6864
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-5400
  • Fax:
Mailing address:
  • Phone: 208-367-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2419
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: