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General NPI Number Information
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NPI Number | 1457089211
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Entity Type | Individual
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Provider Name | JARROD STEPHEN ALTROGGE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 1626 S WELLS AVE STE 105
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City | MERIDIAN
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State | ID
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Zip | 83642-4528
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Country | US
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Telephone | 208-789-0200
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Fax | 208-288-2784
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Provider Business Mailing Address
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Address Line | 3805 E COPPER POINT DR UNIT 0-103
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City | MERIDIAN
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State | ID
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Zip | 83642-7847
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Country | US
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Telephone | 406-839-6988
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Fax | 208-288-2784
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-8292
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License Number State | ID
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