Healthcare Provider Details

I. General information

NPI: 1669602256
Provider Name (Legal Business Name): STEVEN MERRILL BASTIAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S MIDLAND BLVD
NAMPA ID
83686-2601
US

IV. Provider business mailing address

1906 FAIRVIEW AVE STE 410
CALDWELL ID
83605-5407
US

V. Phone/Fax

Practice location:
  • Phone: 208-461-5057
  • Fax: 208-461-5210
Mailing address:
  • Phone: 208-454-9839
  • Fax: 208-454-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2932
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: