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General NPI Number Information
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NPI Number | 1477336105
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Entity Type | Organization
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Legal Business Name | CAROLYN BLOCK PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 1015 W HAYS ST STE 210
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City | BOISE
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State | ID
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Zip | 83702-5412
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Country | US
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Telephone | 208-617-3560
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 W HAYS ST STE 210
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City | BOISE
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State | ID
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Zip | 83702-5412
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Country | US
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Telephone | 208-617-3560
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CAROLYN BLOCK
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Credential | MSPT
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Telephone | 208-559-6979
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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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