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General NPI Number Information
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NPI Number | 1003962036
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Entity Type | Organization
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Legal Business Name | FOCUS PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 1150 W STATE ST STE 301
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City | BOISE
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State | ID
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Zip | 83702-5327
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Country | US
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Telephone | 208-367-1528
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Fax | 208-367-1529
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Provider Business Mailing Address
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Address Line | 1150 W STATE ST STE 301
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City | BOISE
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State | ID
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Zip | 83702-5327
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Country | US
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Telephone | 208-367-1528
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Fax | 208-367-1529
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL JOHN DEVITT
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Credential | PT, DPT, OCS
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Telephone | 208-367-1528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT-859
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License Number State | ID
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