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General NPI Number Information
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NPI Number | 1477190858
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Entity Type | Organization
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Legal Business Name | MIDDLETON PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 1020 W MAIN ST
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City | MIDDLETON
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State | ID
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Zip | 83644-5270
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Country | US
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Telephone | 208-585-3932
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Fax | 208-565-2218
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Provider Business Mailing Address
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Address Line | 1020 W MAIN ST
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City | MIDDLETON
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State | ID
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Zip | 83644-5270
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MARC PATTEN GROW
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Credential | MPT
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Telephone | 208-850-8295
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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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