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General NPI Number Information
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NPI Number | 1245611276
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Entity Type | Individual
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Provider Name | BEAU DOBSON PT, DPT, OCS, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 109 13TH AVE S
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City | NAMPA
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State | ID
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Zip | 83651-3904
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Country | US
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Telephone | 209-995-6671
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Fax |
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Provider Business Mailing Address
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Address Line | 17415 N FLAGSTAFF WAY
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City | NAMPA
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State | ID
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Zip | 83687-5495
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Country | US
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Telephone | 608-558-3657
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Fax | 208-473-7313
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT-4218
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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-4218
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License Number State | ID
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