Healthcare Provider Details

I. General information

NPI: 1588244289
Provider Name (Legal Business Name): CAYLEE MARIE SKOGLUND DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 S VANGUARD WAY STE 110
MERIDIAN ID
83642-7552
US

IV. Provider business mailing address

645 E STATE ST STE 101
EAGLE ID
83616-5915
US

V. Phone/Fax

Practice location:
  • Phone: 208-803-6767
  • Fax: 208-803-6766
Mailing address:
  • Phone: 208-939-9594
  • Fax: 208-939-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: