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General NPI Number Information
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NPI Number | 1356964449
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Entity Type | Organization
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Legal Business Name | VIBRANT PHYSICAL THERAPY & WELLNESS
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Dates
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Enumeration Date | 05/22/2020
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 280 S ACADEMY AVE STE 120
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City | EAGLE
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State | ID
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Zip | 83616-6562
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Country | US
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Telephone | 208-800-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 663 HIALEAH DR
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City | EAGLE
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State | ID
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Zip | 83616-4703
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Country | US
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Telephone | 208-339-0951
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. HEATHER ANN LOWE
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Credential | DPT, ATC, CSCS
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Telephone | 208-339-0951
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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 |
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License Number State |
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