Healthcare Provider Details

I. General information

NPI: 1932023447
Provider Name (Legal Business Name): DELL ROCCO PIKE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9652 W STATE ST
STAR ID
83669-5858
US

IV. Provider business mailing address

9652 W STATE ST
STAR ID
83669-5858
US

V. Phone/Fax

Practice location:
  • Phone: 208-286-0766
  • Fax: 208-286-0768
Mailing address:
  • Phone: 208-286-0766
  • Fax: 208-286-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8581829
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: