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General NPI Number Information
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NPI Number | 1629288923
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Entity Type | Organization
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Legal Business Name | CANYON HAND THERAPY INC.
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1897 ALTURAS DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-4906
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Country | US
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Telephone | 208-539-2784
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Fax | 208-733-1852
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Provider Business Mailing Address
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Address Line | 1897 ALTURAS DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-4906
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Country | US
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Telephone | 208-539-2784
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Fax | 208-733-1852
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRAVIS JAMES NEWTON
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Credential | OTRL CLT
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Telephone | 208-539-2784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT618
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License Number State | ID
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