Healthcare Provider Details

I. General information

NPI: 1427897362
Provider Name (Legal Business Name): NATASHA DAVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2072
EAGLE ID
83616-9111
US

IV. Provider business mailing address

64 S STAR RD STE 2
STAR ID
83669-5497
US

V. Phone/Fax

Practice location:
  • Phone: 208-477-7363
  • Fax:
Mailing address:
  • Phone: 208-488-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-6403
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: