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General NPI Number Information
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NPI Number | 1225235039
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Entity Type | Organization
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Legal Business Name | MAYES PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 1976 S LINCOLN AVE SUITE 6A
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City | JEROME
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State | ID
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Zip | 83338-6150
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Country | US
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Telephone | 208-644-1433
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Fax | 208-644-1434
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Provider Business Mailing Address
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Address Line | 1976 S LINCOLN AVE SUITE 6A
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City | JEROME
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State | ID
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Zip | 83338-6150
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Country | US
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Telephone | 208-644-1433
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Fax | 208-644-1434
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Authorized Official
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Title or Position | OWNER
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Name | DR. DARYL DEAN MAYES
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Credential | P.T., D.P.T., M.H.S.
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Telephone | 208-644-1433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 125
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License Number State | ID
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