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General NPI Number Information
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NPI Number | 1538763370
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Entity Type | Organization
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Legal Business Name | EMPOWER PT, PLLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 804 PANCHERI DR
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3344
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Country | US
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Telephone | 208-403-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 E 343 N
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City | RIGBY
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State | ID
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Zip | 83442-5326
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Country | US
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Telephone | 208-403-7422
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN STODDARD
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Credential | DPT
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Telephone | 208-403-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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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 |
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License Number State |
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