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General NPI Number Information
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NPI Number | 1144213588
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Entity Type | Individual
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Provider Name | GAYLE BONZER-FRY PT
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Gender | Female
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 07/22/2013
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Provider Practice Location Address
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Address Line | 400 HIGHWAY 55 SUITE A
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City | HORSESHOE BEND
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State | ID
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Zip | 83629-9015
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Country | US
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Telephone | 208-793-3333
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Fax | 208-793-6333
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Provider Business Mailing Address
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Address Line | PO BOX 205
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City | HORSESHOE BEND
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State | ID
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Zip | 83629-0205
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Country | US
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Telephone | 208-793-3333
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Fax | 208-793-3666
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | RPT-081
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License Number State | ID
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