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General NPI Number Information
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NPI Number | 1699973826
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Entity Type | Organization
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Legal Business Name | FAMILY PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 834 FALLS AVE STE 1250
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City | TWIN FALLS
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State | ID
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Zip | 83301-3364
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Country | US
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Telephone | 208-733-3900
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Fax | 208-733-3908
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Provider Business Mailing Address
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Address Line | 834 FALLS AVE STE 1250
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City | TWIN FALLS
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State | ID
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Zip | 83301-3364
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Country | US
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Telephone | 208-733-3900
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Fax | 208-733-3908
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Authorized Official
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Title or Position | OWNER / PHYSICAL THERAPIST
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Name | DAVID B LITTLE
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Credential | P.T.
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Telephone | 208-733-3900
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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 | RPT357
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License Number State | ID
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