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General NPI Number Information
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NPI Number | 1497321509
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Entity Type | Organization
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Legal Business Name | INVICTUS RX PLLC
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Dates
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Enumeration Date | 05/29/2021
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 847 LINDSAY BLVD
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City | IDAHO FALLS
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State | ID
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Zip | 83402-1819
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Country | US
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Telephone | 208-504-1895
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Fax | 208-646-4279
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Provider Business Mailing Address
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Address Line | 2085 ALAN ST APT 1
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City | IDAHO FALLS
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State | ID
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Zip | 83404-5792
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Country | US
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Telephone | 208-360-9151
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY MICHAEL DENNING
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Credential | DPT
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Telephone | 208-360-9151
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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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