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General NPI Number Information
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NPI Number | 1366168684
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Entity Type | Organization
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Legal Business Name | PICK PT PHYSICAL THERAPY IDAHO FALLS
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 921 S. UTAH AVE.
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City | IDAHO FALLS
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State | ID
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Zip | 83402
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Country | US
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Telephone | 208-701-2951
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Fax | 208-701-2952
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Provider Business Mailing Address
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Address Line | 921 S. UTAH AVE.
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City | IDAHO FALLS
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State | ID
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Zip | 83402
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Country | US
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Telephone | 208-701-2951
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Fax | 208-701-2952
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Authorized Official
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Title or Position | OWNER
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Name | TREVOR DIMOND
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Credential | DPT
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Telephone | 801-836-4420
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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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