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General NPI Number Information
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NPI Number | 1568587707
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Entity Type | Organization
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Legal Business Name | THERAPY EXPRESS PA
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8024 W SCARDALE CT
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City | BOISE
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State | ID
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Zip | 83704-0713
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Country | US
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Telephone | 208-867-0116
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Fax |
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Provider Business Mailing Address
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Address Line | 3163 N ASH PARK LN
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City | BOISE
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State | ID
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Zip | 83704-5715
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Country | US
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Telephone | 208-867-0116
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL SPERO
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Credential |
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Telephone | 208-867-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OT337
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License Number State | ID
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