Healthcare Provider Details

I. General information

NPI: 1164345005
Provider Name (Legal Business Name): A JOINT VENTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S WOODRUFF AVE
IDAHO FALLS ID
83401
US

IV. Provider business mailing address

268 STONE RUN LN
IDAHO FALLS ID
83404-7248
US

V. Phone/Fax

Practice location:
  • Phone: 720-934-3429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HEIDI DURAN
Title or Position: OWNER
Credential: DPT
Phone: 720-934-3429