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General NPI Number Information
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NPI Number | 1083809008
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Entity Type | Organization
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Legal Business Name | PURE INC
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 01/16/2010
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Provider Practice Location Address
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Address Line | 3655 N GOVERNMENT WAY SUITE 3
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8332
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Country | US
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Telephone | 208-691-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 N GOVERNMENT WAY SUITE 3
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City | COEUR D ALENE
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State | ID
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Zip | 83815-8332
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Country | US
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Telephone | 208-691-8888
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | PETER J FALETTO
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Credential | PT
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Telephone | 208-691-8888
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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 | PT1746
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License Number State | ID
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