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General NPI Number Information
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NPI Number | 1518875616
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Entity Type | Organization
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Legal Business Name | MATADOR PHYSICAL THERAPY AND PERFORMANCE LLC
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 1227 N GALLERIA DR
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City | NAMPA
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State | ID
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Zip | 83687-5228
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Country | US
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Telephone | 208-614-0329
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Fax |
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Provider Business Mailing Address
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Address Line | 3180 S PRIEST RIVER AVE
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City | NAMPA
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State | ID
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Zip | 83686-5092
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Country | US
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Telephone | 385-535-7181
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | COLBY DEE BULLOCK
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Credential | DPT
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Telephone | 208-614-0329
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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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