Healthcare Provider Details

I. General information

NPI: 1639013295
Provider Name (Legal Business Name): ETHAN PLAGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 POLE LINE RD W
TWIN FALLS ID
83301-5810
US

IV. Provider business mailing address

30200 METCALF RD
LOUISBURG KS
66053-7100
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-1000
  • Fax:
Mailing address:
  • Phone: 913-832-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6771562
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: