Healthcare Provider Details

I. General information

NPI: 1174156814
Provider Name (Legal Business Name): SNAKE RIVER PHYSICAL THERAPY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 S WOODRUFF AVE
IDAHO FALLS ID
83401-5299
US

IV. Provider business mailing address

620 S WOODRUFF AVE
IDAHO FALLS ID
83401-5299
US

V. Phone/Fax

Practice location:
  • Phone: 315-486-0731
  • Fax:
Mailing address:
  • Phone: 208-419-3408
  • Fax: 208-419-3412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RENEE WEBER
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 208-419-3408