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General NPI Number Information
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NPI Number | 1205920899
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Entity Type | Organization
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Legal Business Name | WINWARD PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 10 SOUTH 100 WEST STE A WINWARD PHYSICAL THERAPY
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City | PRESTON
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State | ID
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Zip | 83263-1244
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Country | US
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Telephone | 208-852-0116
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Fax | 208-852-0116
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Provider Business Mailing Address
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Address Line | 10 SOUTH 100 WEST STE A WINWARD PHYSICAL THERAPY
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City | PRESTON
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State | ID
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Zip | 83263-1244
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Country | US
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Telephone | 208-852-0116
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Fax | 208-852-0116
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS WINWARD
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Credential | MPT
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Telephone | 208-852-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT-1083
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License Number State | ID
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