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General NPI Number Information
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NPI Number | 1053756882
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Entity Type | Individual
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Provider Name | JOSEPH JANNUZZI DPT, SCS
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Gender | Male
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 2294 S RIVA RIDGE AVE
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City | BOISE
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State | ID
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Zip | 83709-2507
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Country | US
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Telephone | 208-949-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 2294 S RIVA RIDGE AVE
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City | BOISE
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State | ID
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Zip | 83709-2507
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Country | US
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Telephone | 208-949-0568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT-3152
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT-3152
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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