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General NPI Number Information
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NPI Number | 1366180465
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Entity Type | Organization
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Legal Business Name | INSPIRE FUNCTIONAL REHABILITATION AND FITNESS
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 1286 E TUTTLE ST
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City | MERIDIAN
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State | ID
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Zip | 83646-5932
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Country | US
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Telephone | 209-969-2426
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Fax |
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Provider Business Mailing Address
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Address Line | 1286 E TUTTLE ST
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City | MERIDIAN
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State | ID
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Zip | 83646-5932
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Country | US
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Telephone | 801-872-3204
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MARY JOHNSON
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Credential | P.T.
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Telephone | 209-969-2426
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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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