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General NPI Number Information
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NPI Number | 1336847342
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Entity Type | Organization
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Legal Business Name | SIDDHIVINAYAK, LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 3645 E OVERLAND RD
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City | MERIDIAN
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State | ID
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Zip | 83642-6751
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Country | US
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Telephone | 208-703-4950
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Fax |
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Provider Business Mailing Address
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Address Line | 5457 S ASHCROFT WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-6866
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Country | US
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Telephone | 208-703-4950
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GUNJAN D PATEL
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Credential | PT
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Telephone | 208-703-4950
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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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