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General NPI Number Information
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NPI Number | 1457741415
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Entity Type | Organization
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Legal Business Name | ADEPT PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 2691 S 2000 W STE 4
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City | REXBURG
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State | ID
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Zip | 83440-4049
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Country | US
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Telephone | 208-656-3033
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Fax | 208-656-3035
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Provider Business Mailing Address
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Address Line | 2691 S 2000 W STE 4
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City | REXBURG
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State | ID
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Zip | 83440-4049
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Country | US
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Telephone | 208-656-3033
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Fax | 208-656-3035
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Authorized Official
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Title or Position | PHYSICAL THERAPIST / OWNER
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Name | BARRETT J GIBSON
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Credential | PT, DPT
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Telephone | 208-709-6053
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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 | PT-3069
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License Number State | ID
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