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General NPI Number Information
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NPI Number | 1003080813
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Entity Type | Organization
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Legal Business Name | BRYANT BELNAP PA
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 3345 MERLIN DR SUITE 100
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7405
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Country | US
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Telephone | 120-852-2448
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Fax | 120-852-2613
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Provider Business Mailing Address
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Address Line | 3345 MERLIN DR SUITE 100
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7405
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Country | US
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Telephone | 120-852-2448
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Fax | 120-852-2613
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHANNON SCROGHAM
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Credential |
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Telephone | 12085224481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-343
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License Number State | ID
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