Healthcare Provider Details

I. General information

NPI: 1174021620
Provider Name (Legal Business Name): RICHARD SCOTT MACGREGOR DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 SUNNYBROOK DR
NAMPA ID
83686-6332
US

IV. Provider business mailing address

2423 N ARROWWOOD WAY
MERIDIAN ID
83646-4418
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-7298
  • Fax:
Mailing address:
  • Phone: 208-859-5088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-4278
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: