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General NPI Number Information
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NPI Number | 1750588679
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Entity Type | Organization
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Legal Business Name | ORCHARD PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3115 SYCAMORE DR
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City | BOISE
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State | ID
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Zip | 83703-4129
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Country | US
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Telephone | 208-343-7726
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Fax | 208-343-1271
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Provider Business Mailing Address
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Address Line | 3115 SYCAMORE DR
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City | BOISE
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State | ID
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Zip | 83703-4129
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Country | US
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Telephone | 208-343-7726
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Fax | 208-343-1271
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DENNIS J ORCHARD
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Credential | R.P.T.
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Telephone | 208-343-7726
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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 | PT-378
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License Number State | ID
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