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General NPI Number Information
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NPI Number | 1639749534
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Entity Type | Organization
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Legal Business Name | DRAKE REHABILITATION OUTCOMES PLLC
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 3372 E JENALAN
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City | POST FALLS
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State | ID
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Zip | 83854-7787
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Country | US
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Telephone | 208-761-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 2656 S HARMONY AVE
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City | BOISE
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State | ID
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Zip | 83706-5053
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Country | US
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Telephone | 208-761-3080
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | GRANT DRAKE
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Credential | DO
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Telephone | 208-761-3080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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