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General NPI Number Information
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NPI Number | 1689089971
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Entity Type | Organization
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Legal Business Name | ROCK AND ARMOR PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 535 N LOCUST GROVE RD STE 170
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City | MERIDIAN
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State | ID
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Zip | 83642-9020
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Country | US
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Telephone | 208-917-2660
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Fax | 208-917-2630
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Provider Business Mailing Address
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Address Line | 535 N LOCUST GROVE RD STE 170
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City | MERIDIAN
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State | ID
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Zip | 83642-9020
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Country | US
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Telephone | 208-917-2660
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Fax | 208-917-2630
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Authorized Official
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Title or Position | OWNER/PT
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Name | TIMOTHY WILLIAMS
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Credential | PT
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Telephone | 208-917-2660
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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 | PT2867
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License Number State | ID
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