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General NPI Number Information
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NPI Number | 1487735254
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY PODIATRY, INC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 900 N LIBERTY ST SUITE 306
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City | BOISE
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State | ID
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Zip | 83704-8704
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Country | US
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Telephone | 208-367-7887
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Fax | 208-367-7888
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Provider Business Mailing Address
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Address Line | 900 N LIBERTY ST SUITE 306
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City | BOISE
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State | ID
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Zip | 83704-8704
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Country | US
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Telephone | 208-367-7887
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Fax | 208-367-7888
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | MRS. DANA S OWEN
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Credential | DPM
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Telephone | 208-367-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State | ID
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