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General NPI Number Information
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NPI Number | 1588333256
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Entity Type | Organization
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Legal Business Name | IDAHO PHYSICAL REHABILITATION LLC
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Dates
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Enumeration Date | 09/07/2021
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 300 STIBNITE AVE UNIT 1
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City | MCCALL
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State | ID
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Zip | 83638-4407
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Country | US
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Telephone | 800-588-2539
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Fax | 208-329-5807
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Provider Business Mailing Address
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Address Line | 100 N 3RD ST
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City | MCCALL
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State | ID
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Zip | 83638-4401
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Country | US
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Telephone | 800-588-2539
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Fax | 208-329-5807
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Authorized Official
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Title or Position | OWNER
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Name | TARA OSBORNE
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Credential | PT
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Telephone | 208-794-6869
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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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