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General NPI Number Information
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NPI Number | 1639962376
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Entity Type | Individual
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Provider Name | CURTIS CLEVERLY PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 588 FORT HALL AVE
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City | AMERICAN FALLS
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State | ID
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Zip | 83211-1240
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Country | US
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Telephone | 208-722-0698
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Fax |
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Provider Business Mailing Address
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Address Line | 5352 DIAMOND CIR APT 2
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City | CHUBBUCK
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State | ID
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Zip | 83202-2187
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Country | US
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Telephone | 970-215-7181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2171167
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License Number State | ID
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