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General NPI Number Information
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NPI Number | 1174021620
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Entity Type | Individual
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Provider Name | RICHARD SCOTT MACGREGOR DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2018
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Last Update Date | 01/30/2018
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Provider Practice Location Address
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Address Line | 2609 SUNNYBROOK DR
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City | NAMPA
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State | ID
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Zip | 83686-6332
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Country | US
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Telephone | 208-467-7298
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Fax |
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Provider Business Mailing Address
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Address Line | 2423 N ARROWWOOD WAY
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City | MERIDIAN
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State | ID
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Zip | 83646-4418
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Country | US
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Telephone | 208-859-5088
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-4278
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License Number State | ID
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