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General NPI Number Information
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NPI Number | 1386440535
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Entity Type | Organization
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Legal Business Name | RECOVERY RX LLC
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 738 N COLLEGE RD STE B
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City | TWIN FALLS
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State | ID
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Zip | 83301-3386
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Country | US
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Telephone | 208-735-3619
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Fax |
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Provider Business Mailing Address
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Address Line | 3046 N 3422 E
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City | KIMBERLY
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State | ID
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Zip | 83341-5362
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Country | US
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Telephone | 208-421-2754
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | TYLER WAYMENT
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Credential | MD
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Telephone | 208-421-2754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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