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General NPI Number Information
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NPI Number | 1730219361
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Entity Type | Organization
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Legal Business Name | GEM REHABILITATION SERVICES, INC.
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 06/10/2013
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Provider Practice Location Address
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Address Line | 400 HIGHWAY 55 STE A SUITE B
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City | HORSESHOE BEND
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State | ID
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Zip | 83629-9016
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Country | US
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Telephone | 208-793-3333
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Fax | 208-793-6333
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Provider Business Mailing Address
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Address Line | PO BOX 205
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City | HORSESHOE BEND
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State | ID
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Zip | 83629-0205
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Country | US
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Telephone | 208-793-3333
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Fax | 208-621-0234
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. GAYLE FRY
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Credential |
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Telephone | 208-793-3333
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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 |
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License Number State |
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