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General NPI Number Information
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NPI Number | 1235789249
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Entity Type | Organization
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Legal Business Name | HEALTH ATLAST POCATELLO LLC
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 1800 FLANDRO DR STE 110
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City | POCATELLO
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State | ID
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Zip | 83202-4936
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Country | US
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Telephone | 208-242-3723
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Fax | 208-904-1052
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Provider Business Mailing Address
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Address Line | 1800 FLANDRO DR STE 110
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City | POCATELLO
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State | ID
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Zip | 83202-4936
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Country | US
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Telephone | 208-242-3723
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Fax | 208-904-1052
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHALOAM AGALELEI OFISA
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Credential | D.C., M.S.
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Telephone | 208-242-3723
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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