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General NPI Number Information
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NPI Number | 1750478327
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Entity Type | Organization
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Legal Business Name | EAGLE PHYSICAL THERAPY PA
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 457 S FITNESS PL SUITE 100
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City | EAGLE
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State | ID
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Zip | 83616-6568
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Country | US
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Telephone | 208-939-3332
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Fax | 208-939-3338
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Provider Business Mailing Address
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Address Line | 457 S FITNESS PL SUITE 100
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City | EAGLE
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State | ID
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Zip | 83616-6568
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Country | US
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Telephone | 208-939-3332
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Fax | 208-939-3338
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Authorized Official
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Title or Position | OWNER
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Name | MR. RANDALL K LANGLEY
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Credential | MPT, OCS
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Telephone | 208-939-3332
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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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