Healthcare Provider Details

I. General information

NPI: 1205180320
Provider Name (Legal Business Name): STEPHEN RAY PIPE DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 W RIVERSIDE DR
GARDEN CITY ID
83714
US

IV. Provider business mailing address

1411 FALLS AVE E STE 401
TWIN FALLS ID
83301-3455
US

V. Phone/Fax

Practice location:
  • Phone: 208-813-9544
  • Fax: 208-810-4499
Mailing address:
  • Phone: 208-813-9544
  • Fax: 208-810-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60318456
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1381729
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: