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General NPI Number Information
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NPI Number | 1457831745
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Entity Type | Individual
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Provider Name | TAIGAN NEIBAUR
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Gender | Male
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 901 N CURTIS RD STE 204
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City | BOISE
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State | ID
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Zip | 83706-1340
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Country | US
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Telephone | 208-251-6426
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Fax |
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Provider Business Mailing Address
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Address Line | 6871 STAGE COACH RD
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City | NAMPA
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State | ID
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Zip | 83686-1282
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Country | US
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Telephone | 120-825-1642
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Fax |
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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 | PT-5861
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License Number State | ID
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