Healthcare Provider Details

I. General information

NPI: 1144077413
Provider Name (Legal Business Name): MICHAEL ANDREW WREN DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 FALLS AVE E
TWIN FALLS ID
83301-3408
US

IV. Provider business mailing address

1444 FALLS AVE E STE 401
TWIN FALLS ID
83301-3408
US

V. Phone/Fax

Practice location:
  • Phone: 208-736-2574
  • Fax: 208-736-2594
Mailing address:
  • Phone: 208-736-2574
  • Fax: 208-736-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9163
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: