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General NPI Number Information
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NPI Number | 1104979855
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Entity Type | Organization
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Legal Business Name | ANDREASEN PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1808 N 2190 E
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City | SUGAR CITY
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State | ID
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Zip | 83448-1310
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Country | US
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Telephone | 208-201-0877
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Fax |
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Provider Business Mailing Address
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Address Line | 1808 N 2190 E
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City | SUGAR CITY
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State | ID
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Zip | 83448-1310
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Country | US
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Telephone | 208-201-0877
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DIRK ANDREASEN
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Credential | PT
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Telephone | 208-201-0877
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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-737
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License Number State | ID
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