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General NPI Number Information
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NPI Number | 1598222770
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Entity Type | Organization
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Legal Business Name | PT WORKS INC
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 316 W 2ND S
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City | SODA SPRINGS
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State | ID
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Zip | 83276-1515
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Country | US
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Telephone | 208-251-6301
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Fax |
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Provider Business Mailing Address
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Address Line | 316 W 2ND S
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City | SODA SPRINGS
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State | ID
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Zip | 83276-1515
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Country | US
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Telephone | 208-251-6301
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Fax |
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Authorized Official
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Title or Position | MPT, OWNER
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Name | DOUGLAS BALL
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Credential | MPT
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Telephone | 208-251-6301
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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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