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General NPI Number Information
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NPI Number | 1578076519
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Entity Type | Organization
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Legal Business Name | PIERCE PHYSICAL THERAPY AND SPORTS REHAB LLC
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 4771 N SUMMIT WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-5017
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Country | US
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Telephone | 208-629-0656
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Fax | 208-617-3077
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Provider Business Mailing Address
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Address Line | 4771 N SUMMIT WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-5017
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Country | US
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Telephone | 208-629-0656
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. BRETT PIERCE
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Credential | DPT
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Telephone | 208-371-2610
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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 | PT-3309
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License Number State | ID
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