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General NPI Number Information
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NPI Number | 1518175686
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Entity Type | Individual
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Provider Name | ROBERT GRAY VINING III MPT
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Gender | Male
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Dates
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Enumeration Date | 05/20/2007
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 943 N LINDER RD SUITE 104
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City | KUNA
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State | ID
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Zip | 83634-3394
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Country | US
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Telephone | 208-922-1719
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Fax | 208-322-8710
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Provider Business Mailing Address
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Address Line | 2176 E FRANKLIN RD SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-9024
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Country | US
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Telephone | 208-288-1155
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Fax | 208-288-0424
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1158729
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT-2806
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License Number State | ID
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