Healthcare Provider Details

I. General information

NPI: 1811951841
Provider Name (Legal Business Name): BBPT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 IDAHO ST STE A
GOODING ID
83330-1258
US

IV. Provider business mailing address

423 IDAHO ST STE A
GOODING ID
83330-1258
US

V. Phone/Fax

Practice location:
  • Phone: 208-934-9011
  • Fax: 208-934-9014
Mailing address:
  • Phone: 208-934-9011
  • Fax: 208-934-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID B HUTCHINSON
Title or Position: PRESIDENT
Credential: MPT
Phone: 208-934-9011