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General NPI Number Information
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NPI Number | 1013206002
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Entity Type | Organization
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Legal Business Name | SAWTOOTH PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 7979 W RIFLEMAN ST STE 200
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City | BOISE
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State | ID
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Zip | 83704-9066
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Country | US
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Telephone | 208-340-5099
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Fax |
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Provider Business Mailing Address
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Address Line | 235 FLUME ST
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City | BOISE
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State | ID
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Zip | 83712-6318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD D MILLER JR.
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Credential | PT MS OCS
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Telephone | 208-340-5099
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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 1938
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License Number State | ID
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