Healthcare Provider Details

I. General information

NPI: 1376811703
Provider Name (Legal Business Name): JOSEPH MAGGIO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 N ROSARIO ST STE 101
MERIDIAN ID
83642-8095
US

IV. Provider business mailing address

1097 N ROSARIO ST STE 101
MERIDIAN ID
83642-8095
US

V. Phone/Fax

Practice location:
  • Phone: 208-906-8322
  • Fax: 208-629-7059
Mailing address:
  • Phone: 208-906-8322
  • Fax: 208-629-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2707
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: