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General NPI Number Information
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NPI Number | 1235458654
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY REHABILITATION
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 524 CLEVELAND BLVD STE 110
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City | CALDWELL
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State | ID
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Zip | 83605-4079
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Country | US
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Telephone | 208-695-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 524 E CLEVELAND BLVD STE 110
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City | CALDWELL
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State | ID
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Zip | 83605
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Country | US
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Telephone | 208-695-6688
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | BOYD S RICKS
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Credential | OTR/L, DPT
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Telephone | 208-695-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT-810
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT-2172
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License Number State | ID
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